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Background: Although pediatric rhinosinusitis is a commonly encountered clinical entity, the diagnostic approach and treatment algorithm are constantly evolving. In addition to anatomic and allergic etiologies, immunologic deficiencies have been implicated in the pathogenesis of rhinosinusitis; however, the prevalence of immunologic disease in pediatric rhinosinusitis is poorly defined. Objective: To inform the approach to the evaluation of pediatric patients with rhinosinusitis, this retrospective pilot study examined the prevalence of abnormal results detected on immunologic testing in pediatric patients with chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis (RARS). Methods: Patients between 2008 and 2018 were identified using International Classification of Diseases 9/10 codes. Imaging, endoscopy findings, and clinical criteria were used to diagnose CRS and RARS (n = 27). We reviewed available results, including quantitative immunoglobulins (Igs), thyroid evaluation, complete blood count, and titers to Streptococcus, Haemophilus influenzae type B (HiB), Diphtheria, and Tetanus. Statistical analyses were performed with the Mann–Whitney U test and Fisher's exact test. Results: Our initial search yielded 140 patients, of which 27 met diagnostic criteria for CRS (17) or RARS (10). Eight patients (29.6%) underwent adenoidectomy and 5 (18.5%) underwent endoscopic sinus surgery. The most common Ig deficiencies were IgM, 13.0%, and IgA, 11.1%. Four (23.5%) of the 17 patients had significantly elevated IgE levels, indicating a possible allergic etiology. Within this cohort, there was an increased incidence of insufficient protective titers to polysaccharide vaccines. HiB titers were not protective in 35% of our cohort. Insufficient pneumococcal protection was more common in patients >10 years, while deficient IgM was more common in those <10 years. Conclusion: High-yield testing in pediatric rhinosinusitis should include titers to polysaccharide antigens, specifically Streptococcus pneumoniae and H. influenzae. Low-yield tests that may be deferred during initial testing include thyroid studies and Tetanus and Diphtheria antibodies. Prospective, high-volume studies are required to further elucidate the role of immunologic testing in this population. [ABSTRACT FROM AUTHOR]

Background: Respiratory epithelial adenomatoid hamartomas (REAH) are benign nose neoplasms found in the nasal cavity and sinuses. Symptoms include anosmia, nasal obstruction, facial pressure, and rhinorrhea. Although previously thought to be rare, these tumors are being increasingly recognized on pathology in patients undergoing endoscopic sinus surgery. However, REAH is difficult to diagnose before surgery because it may mimic other entities, such as nasal polyps or inverted papilloma, and is often found incidentally only after surgery. Objective: The aims of this study were to (1) add an additional case series of REAH to the literature, (2) report unique imaging findings on computed tomography and magnetic resonance imaging, and (3) pool and summarize all available data from existing publications. Methods: Retrospective chart review from years 2004 to 2015 and a literature review Results: Twenty-three cases were found in our case series, which included 12 men (52%) and 11 women (48%), with a mean age of 59 years. No cases were found before 2007. Lund-Mackay scores were comparable with those found in chronic rhinosinusitis without nasal polyposis. Imaging consistently demonstrated a discoid-shaped mass at the olfactory cleft. Fifty previous publications were found (4 prospective, 11 retrospective studies, 9 case series, 26 cases reports), which included 660 patients diagnosed with REAH. Pooled data revealed a mean age of 54 years (range, 9-86 years) and a male to female ratio of 3:2. Conclusion: The results of our study further refined the average age at which REAH diagnosis occurs as 54 years old, although it may occur at any age. There is a clear male-to-female predominance (3:2). In addition, olfactory cleft widening and discoid soft tissue at the olfactory cleft are hallmark radiographic findings. The vast majority of published cases occurred during the past 4 years, which indicated increased recognition of REAH. [ABSTRACT FROM AUTHOR]

Background: The effect of comorbid conditions such as asthma and atopy on the severity of chronic rhinosinusitis (CRS) and the presence of nasal polyps (NPs) remains an area of investigation. We sought to elucidate the relationship among these entities. Methods: The study population included 106 consecutive patients who were referred to a multidisciplinary, university-based allergy and sinus clinic that underwent computed tomography (CT) scan, skin-prick testing, and had CRS. Data were analyzed to determine Lund-MacKay score (LMS), presence of NPs, asthma status, and sensitivity to seven classes of aeroallergens. Results: Skin tests were positive in 52 cases and negative in 54 cases. Although, there was no statistical relationship between LMS and atopic status in the entire group, among the asthmatic subgroup, mean LMS was greater in nonatopic asthmatic patients than in atopic asthmatic patients. Asthmatic patients had a higher LMS than nonasthmatic patients (p < 0.0001). Asthmatic patients were more likely than nonasthmatic patients to have NPs (57.6% versus 25%; p = 0.0015), regardless of atopic status. Mean LMS was higher in NP patients compared with nonpolyp patients (p < 0.0001), independent of atopic status. Mean LMS was not affected by sensitivity to any particular allergen, with the exception of cockroach-allergic patients who were more likely to have an LMS of >10 (p = 0.0236) and had more severe maxillary sinus involvement (p = 0.0391). Conclusion: These data indicate a strong relationship between CRS severity, as measured by LMS, and chronic airway inflammatory diseases, asthma, and NPs. The association between LMS and atopic status appears weak. The present study suggests that CRS is an inflammatory disease that occurs independently of systemic IgE-mediated pathways. [ABSTRACT FROM AUTHOR]

Fucosidosis is an autosomal recessive lysosomal storage disorder caused by the deficiency of alpha-L-fucosidase. We present the case of an affected female in the second decade of life with chronic rhinosinusitis (CRS) including recalcitrant polypoid inflammation, which has not been previously reported in the literature. With the advancement of life-prolonging measures, children with lysosomal storage disorders may suffer increasingly from CRS due to the lymphohistiocytic and macrophage infiltrate of the paranasal sinus mucosa that resembles severe polypoid inflammation. [ABSTRACT FROM AUTHOR]

Background: Critical review of computed tomography (CT) imaging is essential in preoperative planning for endoscopic sinus surgery. In this study, we used a systematic review and a modified Delphi method to develop a comprehensive checklist that facilitates preoperative review of sinus CT imaging. Methods: We performed a systematic review of PubMed, Embase, CINAHL, Cochrane, and Web of Science databases to identify existing checklists developed to evaluate sinus CT imaging. An inclusive list of items from these checklists was compiled and a modified Delphi methodology was used to assign ranked priority. The Delphi process involved 14 rhinologists and had three phases: an initial survey with Likert priority (scale of 1–9) and two rounds of live discussions followed by survey to confirm consensus. Results: Ninety‐seven possible checklist items were identified from a systematic review and panelist input. On initial survey, 63 items reached a consensus score of 7+, and 13 items had near consensus scores between 6 and 7; two of these 13 borderline items were retained after subsequent panelist discussion. The resulting items were consolidated into an 11‐item disease checklist and a 24‐item anatomical checklist; the anatomical checklist was further divided into six subsections: nasal cavity, maxillary, ethmoid, sphenoid, frontal, skull base, and orbit. Additionally, panelists identified six core aspects of patient history to consider prior to surgery. Conclusions: After establishing content validity through a systematic literature review and a modified Delphi method, we developed a comprehensive checklist for preoperative sinus CT imaging review; implementation and evaluation of validity among trainees will suggest overall utility. [ABSTRACT FROM AUTHOR]