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Background: It is unclear whether chronic rhinosinusitis (CRS) endotypes show a differential response to endoscopic sinus surgery (ESS). We explored patient mucous inflammatory cytokine expression and associations with patient‐reported and clinically measured post‐operative outcome measures. Methods: Patients with CRS were prospectively recruited between 2016 and 2021 into a national multicenter, observational study. Mucus was collected from the olfactory cleft preoperatively and evaluated for 26 biomarkers using cluster analysis. Patient‐reported outcome measures included the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and Questionnaire of Olfactory Dysfunction (QOD). Additional clinical measures of disease severity included threshold, discrimination, and identification (TDI) scores using "Sniffin' Sticks" testing and Lund–Kennedy endoscopic score (LKES). Results: A total of 115 patients were clustered into type 2 inflammatory, non–type 2 inflammatory, noninflammatory, and two indeterminate clusters based on individual protein levels. Overall, the type 2 inflammatory cluster was found to have the highest mean improvement in both SNOT‐22 (−28.3 [standard deviation, ±16.2]) and TDI (6.5 [standard deviation, ±7.9]) scores 6 months after ESS. However, on average, all endotype clusters demonstrated improvement in all outcome measures after ESS without statistically significant between‐group differences in SNOT‐22 (p = 0.738), QOD (p = 0.306), TDI (p = 0.358), or LKES (p = 0.514) measures. Conclusions: All CRS endotype clusters responded favorably to surgery and showed improvements in patient‐reported and objective outcome measures. Thus, ESS should be considered a more generalized CRS therapy, and benefits appear to not be limited to specific endotypes. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, discusses the use of a polydioxanone suture (PDS) plate with a dural substitute for repairing anterior skull base defects. The study reviews a retrospective cohort series of 155 patients who underwent this technique and reports long-term outcomes. The results show that the PDS plate reconstruction is safe and effective, with a low rate of postoperative cerebrospinal fluid (CSF) leaks and no cases of cranial nerve or internal carotid artery injury. The study also suggests that there may be a learning curve associated with this technique. [Extracted from the article]

Objective: The purpose of this study was to analyze barriers to medical care and follow‐up in patients with allergic fungal rhinosinusitis (AFRS). Study Design: Cross‐sectional questionnaire‐based study with retrospective chart review. Setting: Tertiary Medical Center. Methods: Subjects with AFRS and chronic rhinosinusitis with nasal polyps (CRSwNP) were prospectively recruited for completion of the Barriers to Care Questionnaire (BCQ) and formal chart review. Results: Fifty‐nine AFRS and 51 CRSwNP patients participated. AFRS patients were more likely to be lost to follow‐up within 6 months of surgery (35.6% vs 17.7%, P = 0.04) and no‐show at least 1 appointment (20.3% vs 5.9%, P = 0.03) compared to CRSwNP patients. Men with AFRS were more likely to have only a single follow‐up visit (37.0% vs 3.1%, P < 0.001) and be lost to follow‐up (66.7% vs 9.4%, P < 0.001) than women. There were no significant differences in the BCQ between groups; however, rate of questionnaire completion was lower in the AFRS group than the CRS group (62.7% vs 80.4%, P = 0.042). AFRS patients who did not complete the BCQ were more likely to be male (63.6% vs 35.1%, P = 0.034), lost to follow‐up (77.3% vs 10.8%, P < 0.0001), and have a single follow‐up visit (40.9% vs 5.4%, P < 0.0001). Younger age was associated with increased likelihood of having a single follow‐up visit (odds ratio 1.143, 95% CI 1.022‐1.276). Conclusion: Young, male AFRS patients are more frequently lost to follow‐up after surgery and less likely to complete questionnaires assessing barriers to care. Further investigation is needed to assess barriers to follow‐up in these at‐risk groups. [ABSTRACT FROM AUTHOR]

Background: Current methods of quantifying inflammation in chronic rhinosinusitis (CRS) on computed tomography (CT) imaging focus on opacification of the paranasal sinuses and show limited correlation with patient-reported outcome measures. Objective: This study aimed to determine if quantifying CT opacification of the nasal cavity correlated with Sino-Nasal Outcomes Test scores (SNOT-22). Methods: Thirty patients with CRS were enrolled. Lund-Mackay and SNOT-22 scores were measured. Nasal cavity regions of interest (ROIs) were measured by 2 independent raters using ImageJ at 3 points on coronal CT scans: anteriorly at the lacrimal duct, at the approximate midpoint demarcated by the posterior aspect of the globe, and posteriorly at the transition from the hard to soft palate. Superior and inferior regions were defined based upon the root of the inferior turbinate. Percent opacification was calculated for each ROI. Analyses were conducted bilaterally and for the side with greater opacification (worse side). Results: Interrater reliability was strong for all ROIs. Lund-Mackay scores correlated with nasal blockage only (r =.495, P =.01) and did not correlate with nasal cavity ROI opacification. Inferior nasal cavity opacification for worse-sided anterior ROI and middle ROI correlated with SNOT-22 scores for nasal blockage (anterior r =.41, P =.03) (middle r =.42, P =.023) and runny nose (anterior r =.44, P =.02) (middle r =.38, P =.04). Posterior ROIs did not correlate with SNOT-22. Conclusions: Traditional CT scoring of sinus opacification does not correlate well with nasal cavity opacification or SNOT-22. Inferior nasal cavity inflammation provides unique correlations with SNOT-22 nasal questions and may guide targeted interventions in these regions. [ABSTRACT FROM AUTHOR]

Objectives: To perform a systematic review of otolaryngologic presentation rates to emergency department settings before and after lockdown due to the COVID-19 pandemic. Sources: PubMed, Scopus, and CINAHL. Methods: A systematic search was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for studies describing otolaryngologic presentations to emergency department and rapid access clinic settings both in the before-lockdown and after-lockdown periods. The start of after-lockdown period varied based on initiation of lockdown, ranging from March 1st to June 1st of 2020 across general emergency department studies. Results: A total of 14 studies were included in this review. About 10 were general emergency departments, 3 were specifically pediatric emergency departments, and 1 study focused on the geriatric population (>65 years). A total of 13 790 patients were included, with 9446 in the before-lockdown period (68.5%) and 4344 in the after-lockdown period (31.5%). Meta-analysis of proportions for otolaryngologic presentations across general emergency departments was performed. Comparison of weighted proportions found significant differences between before-lockdown and after-lockdown presentation rates for infectious etiologies, tonsillitis specifically, foreign bodies, non-infectious airway issues, and epistaxis among these studies. Conclusions: The increased proportions of various non-infectious presentations (eg, epistaxis, foreign bodies, and airway issues) following lockdown might be associated with proportional decreases in infectious pathologies, given decreased social contact to prevent SARS-CoV-2 transmission. Overall, it is important for otolaryngologists to recognize what presentations might more commonly be seen and require evaluation and potential intervention in light of a global pandemic. [ABSTRACT FROM AUTHOR]

Objective: Some previous studies have shown an increased prevalence of allergic fungal rhinosinusitis (AFRS) among young, black patients with poor access to health care; however, results have been mixed. The purpose of this study was to investigate the relationship between social determinants of health and AFRS. Data Sources: PubMed, Scopus, CINAHL. Review Methods: A systematic review was performed searching for articles published from date of inception to September 29, 2022. English language articles describing the relationship between social determinants of health (i.e., race, insurance status) and AFRS as compared to chronic rhinosinusitis (CRS) were selected for inclusion. A Meta‐analysis of proportions with comparison (Δ) of weighted proportions was conducted. Results: A total of 21 articles with 1605 patients were selected for inclusion. The proportion of black patients among AFRS, chronic rhinosinusitis with nasal polyps (CRSwNP), and chronic rhinosinusitis without nasal polyps (CRSsNP) groups was 58.0% [45.3%‐70.1%], 23.8% [14.1%‐35.2%], and 13.0% [5.1%‐24.0%], respectively. This was significantly higher among the AFRS population compared to both the CRSwNP population (Δ34.2% [28.4%‐39.6%], p <.0001) and the CRSsNP population (Δ44.9% [38.4%‐50.6%], p <.0001). The proportion of patients who were either uninsured or covered by Medicaid among the AFRS, CRSwNP, and CRSsNP populations was 31.5% [25.4%‐38.1%], 8.6% [0.7%‐23.8%], and 5.0% [0.3%‐14.8%], respectively. This was significantly higher among the AFRS group than the CRSwNP group (Δ22.9% [15.3%‐31.1%], p <.0001) and the CRSsNP group (Δ26.5% [19.1%‐33.4%], p <.0001). Conclusion: This study confirms that AFRS patients are more likely to be Black and either uninsured or on subsidized insurance than their CRS counterparts. [ABSTRACT FROM AUTHOR]

Objective: To investigate novel methods of measuring intranasal trigeminal function and correlate to validated measures of trigeminal function. Study Design: Prospective cohort study. Setting: Tertiary medical center. Methods: Forty‐one subjects without nasal congestion were assessed. The trigeminal temperature function of the cool/warmth detection threshold and cold/heat pain threshold was measured with the Thermal Sensory Analyzer (TSA) device, as previously validated at buccal mucosa and infraorbital skin. Identical temperature sensory function was assessed at the anterior septum and inferior turbinate. Lateralization of trigeminal odorants eucalyptol, isothiocyanate, and acetic acid was conducted. Visual analog scales (VAS) of trigeminal function were collected. Results: Extraoral cheek site and oral site thermal measures were moderately correlated, suggesting consistent assessment of trigeminal function. Nearly all intranasal thermal measures correlated between the septum and turbinate (significant correlations [ρ] ranged from.3 to.8). Oral and extraoral cheek sites had modest correlations to intranasal cold and heat pain (ρ =.4‐.5). The oral site had modest correlations of cold and heat detection to intranasal sites, with turbinate appearing to have the most correlations. Isothiocyanate lateralization was the most closely correlated to intranasal thermal scores for cold and heat pain. Turbinate thermal measures had weak correlations with trigeminal VAS scores (ρ =.3‐.4). Conclusion: Intranasal trigeminal measures of thermal function correlate to validated extraoral and intraoral thermal measures. The turbinate appears to have stronger correlations to the septum than found in the mouth and face. TSA testing might provide a rapid, novel method of intranasal trigeminal function assessment. [ABSTRACT FROM AUTHOR]

Introduction: Patients often describe the olfactory loss as either the inability to detect unpleasant odors (eg, smoke or spoiled food) or noticeable impairment in enjoying pleasant odors (eg, food and fragrances). This complex relationship between the hedonics of various odors, their perceived magnitude in odor strength, and the impact on patient quality of life is not well understood. Methods: Sixty-five subjects underwent testing with the Henkin olfaction test which assesses hedonics and magnitude for odors traditionally deemed unpleasant (pyridine/dead fish and thiophene/gasoline) and pleasant (amyl acetate/banana and nitrobenzene/almond). Subjects also completed Smell Identification Test-40 (SIT-40), Sniffin' Sticks (Sniffin' Sticks), and Snap & Sniffin' Sticks (Snap) Olfactory Tests, as well as the 17-item Questionnaire for Olfactory Disorders Negative Statements (QODNS) and olfactory symptom visual analog scale (VAS). Spearman's rank correlations were conducted between various olfactory domains, QODNS and VAS. Results: Mean age was 52.1 years (range: 28-86), with 63.1% females. Magnitude estimation was greatest for pyridine. Most people rated thiophene (75.4%) and pyridine (92.3%) as "unpleasant." Although most people rated amyl acetate (47.7%) and nitrobenzene (56.9%) as "pleasant," many rated amyl acetate (52.3%) and nitrobenzene (43.1%) as "neutral" or "unpleasant" scents. Hedonics for unpleasant odors correlated with each other (rs = 0.60), but not with hedonics for pleasant odors. Hedonics for unpleasant odors also correlated with magnitude estimation and other psychophysical tests. These findings were not seen for hedonics of pleasant odors. Conclusions: The use of unpleasant odors in Henkin testing showed unique relationship patterns with patient-reported outcome measures and validated olfactory tests, which may provide utility in characterizing olfactory dysfunction. The incorporation of more unpleasant odors in current psychophysical olfactory testing may provide enhanced information regarding the patient impact of olfactory dysfunction. [ABSTRACT FROM AUTHOR]

Objective: Demographic minorities are underrepresented in clinical trials. For the approval of new drug applications (NDAs), the Food and Drug Administration (FDA) has asserted that clinical trial enrollment should represent the demographics of patients likely to receive the trial drug. The aim of this study is to assess the demographics of clinical trials included in NDAs and biologics license applications (BLAs) approved by the FDA since 1990 for allergic rhinitis (AR), a condition whose demographic prevalence mirrors the US population. Methods: Federal Freedom of Information Act requests were submitted to the US government to obtain documents related to all relevant NDAs and BLAs. The Drugs@FDA database was queried for all clinical trial documentation. Demographic data were extracted from clinical trials used to inform FDA approval for AR pharmacotherapies. Demographics were analyzed relative to national US Census data. Results: Since 1990, 22 drugs have been approved for AR. The racial, ethnic, and sex composition of all included study populations differed significantly (p < 0.05) from the demographics of AR and from US Census data. Most NDAs and BLAs included overrepresentation of White participants and underrepresentation of Black, Asian, Pacific Island, Native American, and Hispanic participants. Conclusion: The patients enrolled in clinical trials used to inform FDA approval for AR pharmacotherapeutics do not represent the demographics of the United States or the demographics of AR. The clinical significance of unrepresentative demography between study and treatment populations has been examined for several medical disorders, but has not been studied for AR. Level of Evidence: 4 Laryngoscope, 133:755–763, 2023 [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review of proposed sinus computed tomography (CT) scoring systems and determine their association with patient‐reported outcome measures (PROMs). Data Sources: PubMed, CINAHL, Scopus, and Cochrane Library. Review Methods: A systematic search was conducted following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta‐analyses) for studies describing CT scores and PROMs in patients with chronic rhinosinusitis. Results: A total of 144 studies were included. Out of 20,741 patients, 53.6% were male and 55.5% had nasal polyposis. A meta‐analysis of correlations revealed a moderate correlation between Lund‐McKay (LM) and the 22‐item Sinonasal Outcome Test (SNOT‐22; r = 0.434, P <.001) and a weaker correlation between LM and the 20‐item Sinonasal Outcome Test (SNOT‐20; r = 0.257, P =.039). Meta‐regression also revealed a weak association between LM and SNOT‐20 (n = 25 studies) but no significant associations between Zinreich score and SNOT‐22 or LM scores and PROMs, including SNOT‐22 (n = 94 studies), Rhinosinusitis Disability Index (n = 25), nasal obstruction visual analog scale (n = 15), Chronic Sinusitis Survey (n = 12), Total Nasal Symptom Score (n = 4), Total Symptom Score (n = 3), and 12‐Item Short Form Health Survey (n = 3). Conclusion: There is essentially little association between radiologic grade and PROMs. CT grading systems with improved clinical utility are needed. [ABSTRACT FROM AUTHOR]

Keywords: allergic rhinitis; allergies; anxiety; depression; mood disorders EN allergic rhinitis allergies anxiety depression mood disorders 1489 1491 3 07/26/23 20230801 NES 230801 SUMMARY Our patients today stand at the junction of two worrisome trends: allergy seasons are worsening, and rates of depression and anxiety are rising.[[1], [3]] We may not often think about the relationship between allergic rhinitis (AR) and mood disorders, but their increasing incidence and severity should serve as a reminder of their remarkable association. Allergy treatment can improve symptoms of both allergies and concomitant mood disorders, and simultaneously treating mood disorders with therapy appears to help even more.[28] However, we cannot offer appropriate treatment or referrals if we do not know what our patients experience. Rhinologists should likewise make patients aware of the association between AR and mood disorders and feel comfortable inquiring about such symptoms. Whether by administering validated mood disorder patient-reported outcome instruments, or simply by maintaining open and nonjudgmental inquiry and support for our patients, identifying and addressing concomitant mood disorders facilitates holistic patient care. [Extracted from the article]

Background: Various surgical interventions exist for treatment of inferior turbinate hypertrophy (ITH). Though mucosal-sparing techniques are generally preferred, there is lack of consensus on the optimal technique. Objective: This systematic review sought to evaluate the evidence for treatment of bilateral nasal obstruction via inferior turbinate reduction (ITR) and provide a meta-analysis of expected results of various techniques. Methods: PubMed, Scopus, Cochrane Library databases were queried to include articles describing surgical treatment for ITH. Exclusion criteria were concurrent nasal procedures or non-mucosal ITH. Primary outcomes included visual analog scale for nasal obstruction, nasal cavity volume by acoustic rhinometry, and resistance by anterior rhinomanometry. Subgroup analyses assessed outcomes by rhinitis diagnosis and length of follow-up, and radiofrequency ablation (RFA) was compared to microdebrider-assisted turbinoplasty (MAIT). Results: A total of 1870 studies were identified with 62 meeting inclusion criteria. Reported techniques included turbinectomy, submucosal resection, RFA, MAIT, laser, or electrocautery. All techniques demonstrated significant improvements in nasal obstruction using the visual analog scale. Further comprehensive physiologic data for RFA, MAIT, and laser was available and, compared to baseline, these techniques resulted in significant improvements in nasal resistance, nasal cavity volume, and nasal airflow. Six studies directly compared RFA and MAIT with statistically similar results on VAS, nasal cavity volume, and resistance with median follow-up time of 3.5 months. Assessment of VAS congestion over time reveals peak benefit is achieved between 3–6 months follow-up. Conclusions: All reviewed ITR techniques improve patient-reported nasal obstruction. RFA and MAIT provide comparable improvements in patient-reported and physiologic nasal airflow outcomes and while benefits are sustained long-term, the peak benefit for both techniques appears to be achieved within the first year. [ABSTRACT FROM AUTHOR]

Background: Olfactory dysfunction (OD) can occur from a variety of etiologies. However, there are few reports examining whether varying etiologies have unique profiles of psychophysical testing that may provide insight into the pathophysiology of OD. Methods: Adults with chronic rhinosinusitis with and without nasal polyps (CRSwNP/CRSsNP) and healthy control adults with no sinus complaints underwent olfactory assessment with Sniffin' Sticks. Profiles of identification and discrimination were compared between CRS and non-CRS subjects across the spectrum of OD. Results: Normosmics with or without CRS identified apple, pineapple, and turpentine less frequently than expected (range 52%-68% correct). Hyposmics with CRS correctly identified orange more frequently than control hyposmics (83%-93% vs 68% for controls) with similar findings for rose. Hyposmics of all cohorts were unable to identify apple (26%). Discrimination profiles were similar across the spectrum of OD and between diagnostic groups. Conclusions: Identification and discrimination rates of specific odorants may provide unique information regarding the etiology of OD, however psychophysical testing is a complex interplay of olfactory and trigeminal function, the strength of target odorant, distractor choices, and familiarity with odorants. [ABSTRACT FROM AUTHOR]

Background: Current clinical classifications of olfactory function are based primarily upon a percentage of correct answers in olfactory identification testing. This simple classification provides little insight into etiologies of olfactory loss, associated comorbidities, or impact on the quality of life (QOL). Methods: Community-based subjects underwent olfactory psychophysical testing using Sniffin Sticks to measure threshold (T), discrimination (D), and identification (I). The cognitive screening was performed using Mini-Mental Status Examination (MMSE). Unsupervised clustering was performed based upon T, D, I, and MMSE. Post hoc differences in demographics, comorbidities, and QOL measures were assessed. Results: Clustering of 219 subjects, mean age 51 years (range 20-93 years) resulted in 4 unique clusters. Cluster 1 was the largest and predominantly younger normosmics. Cluster 2 had the worst olfaction with impairment in nearly all aspects of olfaction and decreased MMSE scores. This cluster had higher rates of smoking, heart disease, and cancer and had the worst olfactory-specific QOL. Cluster 3 had normal MMSE with relative preservation of D and I, but severely impaired T. This cluster had higher rates of smoking and heart disease with moderately impaired QOL. Cluster 4 was notable for the worst MMSE scores, but general preservation of D and I with moderate loss of T. This cluster had higher rates of Black subjects, diabetes, and viral/traumatic olfactory loss. Conclusion: Unsupervised clustering based upon detailed olfactory testing and cognitive testing results in clinical phenotypes with unique risk factors and QOL impacts. These clusters may provide additional information regarding etiologies and subsequent therapies to treat olfactory loss. [ABSTRACT FROM AUTHOR]

Background: Nasal mucus is proving to be a useful means by which to study the pathogenesis of chronic rhinosinusitis (CRS). Given the increase in publications examining nasal mucus and the lack of a review on this topic, we will focus on this noninvasive approach to studying CRS. Particular attention will be drawn towards inflammatory cytokines and biomarkers and their influence on disease severity. Methods: A literature review of papers published in English pertaining to nasal mucus was performed using the PubMed database. The search utilized combinations of the following keywords: sinusitis, polyps, sample collection, nasal mucus, or nasal secretion. Studies solely on acute or bacterial sinusitis, allergic rhinitis, or cystic fibrosis were not included. Results: A wide variety of materials and methods have been used to collect nasal mucus. Numerous assay types have been performed with the most common being ELISA, cytometric bead array, and proteomics. Most studies have focused on examining the levels of Th1/Th2 cytokines along with chemokines associated with type 2 immunity. Other factors identified include growth factors, senescence-associated proteins, complement, and antimicrobial defenses have also been identified. Nasal mucus cytokines have proven useful in cluster analysis and predicting postoperative improvement in Sino-nasal Outcome Test (SNOT-22) scores. One limitation of the use of nasal mucus is that some studies have suggested that nasal mucus does not always reflect the tissue microenvironment. Conclusions: Nasal mucus represents a critical tool by which to examine the sinonasal microenvironment in a noninvasive manner. Unlike studies of tissue, it can be utilized in both surgically and medically managed patients and avoids the trauma of biopsies. However, studies are still needed to determine the most effective method for nasal mucus collection. Studies should also take care to confirm that nasal mucus markers do, in fact, reflect the levels of the product studied in the tissue. [ABSTRACT FROM AUTHOR]