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Objectives: Midline nasal masses are rare and challenging for surgeons. This study examined the site with the highest risk of recurrence following midline nasal mass excisions. Methods: Surgical outcomes were retrospectively reviewed following excision of midline nasal masses between 2010 and 2022 in the predominantly pediatric patient cohort. The primary outcome measure was the recurrence rate. Results: Overall, 22 nasal masses were resected from 20 patients. Of these masses, 16 were nasal dermoid sinus cysts (NDSC), 2 were hamartomas, 1 was an epidermoid cyst, and 1 was a mature teratoma. Five of the nasal masses were classified as intracranial lesions, 11 were classified as intraosseous lesions, and 6 were classified as superficial lesions. The open rhinoplasty approach was chosen in 65% of the surgeries. For the intracranially extended lesions, a combined nasocranial approach was performed. Four revision surgeries were performed due to superficial recurrences at the nasal dorsum of lesions, that were primarily classified as intraosseous lesions. Conclusions: All recurrences had a superficial extension and were easily excised. Intraosseous NDSC have the highest risk of recurrence, but conversely, they also occur most frequently. [ABSTRACT FROM AUTHOR]

Purpose: This study proposes the Lamella Ostium Extent Mucosa (LOEM) system as a compact and user-friendly classification for endoscopic sinus surgery (ESS), based on surgical bone extension and mucosal management, aiming to resolve inconsistencies in describing surgical techniques and extension levels, and to enhance comparability of outcomes in chronic rhinosinusitis (CRS). Methods: LOEM uses a lettering system representing a specific topographical level: L identifies the lamellae, O the ostia, E the opening of the sinus walls, and M the mucosal approach. Eleven CRS surgical cases were independently evaluated by seven rhinologists following a Delphi method in two consecutive rounds. Consensus was assessed using Cohen's kappa. Results: A substantial agreement was found among the experts (κ = 0.77) in the first round, although the M item only showed fair agreement (κ = 0.37). Clarifications for this item were given in the second round, after which, the overall agreement increased to κ = 0.81 and to κ = 0.79 for the M item. A decrease in agreement from substantial to moderate for O and E items in the second round was found. Test–retest analysis showed an almost perfect agreement (92.96%, κ = 0.82). In this study, a web-based app is provided to assist with the regular use of the LOEM system. Conclusions: The LOEM system provides a compact, comprehensive code for ESS, integrating anatomical and functional aspects to represent surgical techniques described so far. This system may be suitable for facilitating communication between surgeons and collecting robust labeled data, hopefully leading to further standardization and validation of surgical approaches in future CRS studies. [ABSTRACT FROM AUTHOR]

Background: Fungal balls within the nasal cavity are an exceedingly rare clinical entity, typically presenting with nonspecific symptoms or being identified incidentally., Case Summary: This report presents an incidental discovery of a fungal ball in the nasal cavity during routine imaging, with no associated clinical symptoms., Conclusion: This case underscores the importance of considering the possibility of asymptomatic presentations of nasal fungal balls, which may be detected incidentally during imaging evaluations., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: To assess the effect of allergen immunotherapy (AIT) on patients with central compartment atopic disease (CCAD) and house dust mite (HDM) sensitization post-surgery., Methods: A retrospective cohort of surgically treated, HDM-sensitized CRSwNP patients phenotyped as CCAD was assessed. Patients were divided into two groups based on whether they had AIT commenced as part of their surgical care. All AIT patients started immunotherapy prior to their surgery. The primary endpoint was reformation of middle turbinate (MT) edema 12 months postsurgery. Secondary endpoints were corticosteroid irrigation use (<4 times/week vs. ≥4 times/week, %) and the rhinologic domain of the 22-item sino-nasal outcome test (SNOT-22). Demographic characteristics, concomitant asthma, smoking status, history of aspirin-exacerbated respiratory disease, conjunctival symptoms, polysensitization, serum eosinophils (cell × 10 9 /L), tissue eosinophilia (% > 100/HPF), and serum IgE (kU/L) were also recorded., Results: Eighty-six CCAD patients were assessed (41 ± 14 yrs, 64% female). AIT was applied in 37% (n = 32). Baseline features were similar apart from greater conjunctival symptoms (72 vs. 45%, p = 0.02) in the AIT group. At 12 months post-surgery, the AIT group has less MT edema (% ≥ diffuse 15.6 vs. 52.9, p < 0.01). Patients on AIT also had less pharmacotherapy requirements at 12 months (% ≥ 4/week, 37.5 vs. 79.6%, p < 0.01). The rhinologic symptoms were similar (21.1 ± 17.1 vs. 20.1 ± 21.6, p = 0.83)., Conclusions: Surgery and pharmacotherapy are effective in managing CCAD, but the addition of AIT improved allergic phenomenon and allowed de-escalation of topical therapy. Longer term studies are required to demonstrate further immunomodulation., (© 2024 The Author(s). International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.)

Background: Olfactory dysfunction (OD) is a key symptom of chronic rhinosinusitis (CRS). Although extensively studied in CRS with nasal polyps (CRSwNP), OD in CRS without nasal polyps (CRSsNP) remains under-researched. This study aims to assess the prevalence of OD and its evolution in surgically naïve patients with CRSsNP undergoing endoscopic sinus surgery (ESS)., Methods: This prospective study included 97 participants with CRSsNP (mean age, 46.5 years; 70.1% men) and 97 healthy controls (mean age, 46.5 years; 70.1% men). Participants underwent psychophysical evaluations of orthonasal (using the Sniffin' Sticks test) and retronasal olfaction (using powdered aromas) at enrolment and 6 months post-ESS., Results: Out of 97 patients, 81 (83.5%) completed all assessments. At enrolment, 23 (28.4%) CRSsNP patients had OD based on composite threshold, discrimination, identification scores, compared with 7 (8.6%) controls (absolute % difference, 19.8% [95% CI, 8.2-31.4]). Retronasal olfactory function was also significantly worse in CRSsNP patients. Six months post-ESS, 30 patients (37.0%) experienced a clinically significant improvement in olfactory, whereas nonsignificant changes were observed in retronasal olfactory score, and 3.7% of patients experienced a deterioration of the olfactory function., Conclusions: In conclusion, although 37% of patients experienced a clinically significant improvement in their sense of smell following ESS, the overall prevalence of OD in this surgically naive population appears relatively low, especially when compared to that observed in patients with CRSwNP. Therefore, ESS may offer some benefits for enhancing orthonasal olfactory function, but the extent of these improvements appears to be limited., (© 2024 The Author(s). International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.)

Background: The septal swell body (SSB), a distinct anatomical structure located in the anterior nasal septum, has been recognized as a significant contributor to nasal obstruction, impacting airflow dynamics and nasal resistance. This meta-analysis evaluated the impact of septal swell body volume reduction (SSBVR)., Methods: A systematic review of studies from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases was conducted through October 2024. Outcomes included changes in nasal obstruction scores, cross-sectional area, and nasal airway resistance pre- and post-SSBVR. Standardized mean differences (SMDs) were calculated, and the effectiveness of SSBVR combined with turbinate surgery was compared to turbinate surgery alone., Results: Seven studies involving 232 patients were analyzed. SSBVR significantly improved crosssectional area (SMD = -1.05, 95% CI [-1.88; -0.21]) and nasal airway resistance (SMD = -0.67, 95% CI [-0.89; -0.45]), while nasal obstruction scores demonstrated significant improvements over up to 12 months (SMD = 2.54, 95% CI [1.81; 3.26]). The addition of SSBVR to turbinate surgery resulted in greater improvement in nasal obstruction scores (SMD = 0.47, 95% CI [0.24; 0.70]) compared to turbinate surgery alone, though no significant differences were observed in crosssectional area or nasal airway resistance. Subgroup analyses revealed time-dependent improvements in nasal obstruction scores and variability in effectiveness based on treatment modality., Conclusion: : SSBVR significantly improves nasal obstruction and airflow metrics, with added benefits when combined with turbinate surgery. Further randomized trials are warranted to validate these findings and optimize treatment strategies.