Search

Purpose: Nowadays, several efficacious biologic drugs are used for severe asthma with or without chronic rhinosinusitis with nasal polyps (CRSwNP). However, it has been observed that not all comorbid patients (asthma/CRSwNP) receiving biologic treatment for asthma experience satisfactory control of both conditions equally., Methods: We selected 20 patients who had both severe asthma and comorbid CRSwNP under biological treatment with benralizumab, omalizumab or mepolizumab with adequate control of asthma but inadequate control of nasal symptoms. Patients were switched to dupilumab and outcomes were evaluated at baseline (T0), at 3 months (T1), at 6 months (T2), at 12 months (T3) and finally at 18 months (T4). Data were collected at each time point including blood tests measuring eosinophil levels and total IgE, SNOT22, ACT, NPS score, rhinomanometry, olfactory testing, and nasal cytology., Results: The results showed an overall improvement in all the outcomes. Peripheral eosinophilia was observed consistently with existing literature. All patients registered an improvement in sinonasal outcomes, while only one patient had a worsening of asthma. Three patients interrupted the therapy due to various causes: poor asthma control, onset of psoriasis and thrombocytopenia., Conclusions: The response to a biologic treatment for CRSwNP control may be heterogenous and it seems that patients may benefit from switching improving control in equal measure in the upper and lower airway. Further studies to explore the endotype/phenotype which best fits with each biologic are mandatory to personalize the therapy., (© 2024. The Author(s).)

Introduction: Biologic therapies for Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) have emerged as an auspicious treatment alternative. However, the ideal patient population, dosage, and treatment duration are yet to be well-defined. Moreover, biologic therapy has disadvantages, such as high costs and limited access. The proposal of a novel Artificial Intelligence (AI) algorithm offers an intriguing solution for optimizing decision-making protocols., Methods: The AI algorithm was initially programmed to conduct a systematic literature review searching for the current primary guidelines on biologics' clinical efficacy and safety in treating CRSwNP. The review included a total of 12 studies: 6 systematic reviews, 4 expert consensus guidelines, and 2 surveys. Simultaneously, two independent human researchers conducted a literature search to compare the results. Subsequently, the AI was tasked to critically analyze the identified papers, highlighting strengths and weaknesses, thereby creating a decision-making algorithm and pyramid flow chart., Results: The studies evaluated various biologics, including monoclonal antibodies targeting Interleukin-5 (IL-5), IL-4, IL-13, and Immunoglobulin E (IgE), assessing their effectiveness in different patient populations, such as those with comorbid asthma or refractory CRSwNP. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, demonstrated significant improvement in nasal symptoms and quality of life in patients with CRSwNP in several randomized controlled trials and systematic reviews. Similarly, mepolizumab and reslizumab, which target IL-5, have also shown efficacy in reducing nasal polyp burden and improving symptoms in patients with CRSwNP, particularly those with comorbid asthma. However, additional studies are required to confirm the long-term efficacy and safety of these biologics in treating CRSwNP., Conclusions: Biologic therapies have surfaced as a promising treatment option for patients with severe or refractory CRSwNP; however, the optimal patient population, dosage, and treatment duration are yet to be defined. The application of AI in decision-making protocols and the creation of therapeutic algorithms for biologic drug selection, could offer fascinating future prospects in the management of CRSwNP., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Recovery of olfactory function plays a prominent role in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). While rates and timing of such recovery vary, monoclonal antibodies might yield better results which we aimed at evaluating with this study., Methodology: A prospective controlled study was conducted at our tertiary otolaryngological center from April 1, 2021, to October 1, 2022, in CRSwNP patients. We included an active group (n = 60 patients) performing dupilumab treatment and a control group (n = 60 patients) treated with intranasal and oral corticosteroids. Primary endpoints were changes in smell visual analogical scale (VAS) and SS-I (Sniffin' Sticks-identification) scores, and olfactory recovery rate. The secondary efficacy endpoints were nasal obstruction, rhinorrhea, headache, SNOT-22, and nasal congestion score (NCS)., Results: At 6 months, the active group demonstrated better outcomes than control in SS-I scores (10.23 ± 4.21 vs.3.68 ± 3.08; p < 0.001). No significant differences were found in blood eosinophil count, SNOT-22, and NPS (p > 0.05 for all). Olfactory function in the treatment arm improved in 86.66% (52/60 cases), with normal scores in 48.33% (29/60), while the control group reported a lower recovery rate (3/60; 5%), with no normal olfaction cases. Log-rank comparison for Kaplan-Meier functions was statistically significant (p < 0.001), but no differences were found in subanalysis in the active group based on blood eosinophil count at baseline, SNOT-22, and NPS scores., Conclusions: Patients who receive dupilumab treatment may experience a faster recovery of olfactory function compared to those receiving corticosteroid therapy. This result would be maintained regardless of the severity of type 2 CRSwNP inflammation, the volume of the polyps, or the patient's subjective symptomatology., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To analyze as the primary endpoint the accuracy, sensitivity, and specificity of the SNOT-22 assessing CRS severity and to compare the results with a version of the SNOT-8 obtained from the nasal domain items., Methods: Data were obtained from a prospective multicenter controlled study of dupilumab in adults with moderate-severe CRSwNP. EQUATOR and STROBE network guidelines were adopted. A multivariate logistic regression model was used to evaluate the accuracy of the model with the full (SNOT-22) and reduced (SNOT-8) item set to predict the severity outcome., Results: SNOT-22 demonstrated an AUC of 0.885 (95% CI 0.825, - 0.945), and sensitivity and specificity of 91.49% (83.92-96.25%) and 69.23% (48.21-85.67%), respectively. Interestingly, after stepwise items elimination good outcomes were reported for SNOT-8, with an AUC of 0.818 (95% CI 0.744-0.892), achieving a sensitivity of 93.51% (85.49-97.86%) and specificity of 57.14% (40.96-72.28%)., Conclusion: Psychometric analyses support the accuracy, sensitivity, and specificity of the nasal domains of SNOT-22 to assess the impact on HRQoL in patients with CRSwNP., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The surgical approach to refractory hypertrophy of the inferior turbinates is the main therapeutic choice in the management of its symptoms. Although submucosal approaches have demonstrated efficacy, long-term results are debated in the literature and show variable stability. Therefore, we compared the long-term outcomes of three submucosal turbinoplasty methods with regard to the efficacy and stability managing the respiratory disorders., Design: Multicenter prospective controlled study. A computer-generated table was used to allocate participants to the treatment., Setting: Two teaching and university medical centers., Methods: We used the EQUATOR network for guidelines describing design, conduct, and reporting of studies and searched the references of these guidelines to identify further relevant publications reporting adequate study protocols. Patients with persistent bilateral nasal obstruction due to lower turbinate hypertrophy were prospectively recruited from our ENT units. Participants were randomly assigned to each treatment and then underwent symptom assessment by visual analog scales, endoscopic assessment at baseline and 12, 24 and 36 months after treatment., Results: Of the 189 patients with bilateral persistent nasal obstruction initially assessed, 105 met the study requirements; 35 were located in the MAT group, 35 in the CAT group and 35 in the RAT group. Nasal discomfort was significantly reduced after 12 months with all the methods. The MAT group presented better outcomes for all VAS scores at the 1-year follow-up, greater stability at the 3-year follow-up for VAS results (p < 0.001 in all cases) and lower disease recurrence (5/35; 14.28 %). At the 3-year follow-up intergroup analysis, a statistically significant difference was confirmed except for RAA scores (H = 2.88; p = 0.236). Rhinorrhea (r = -0.400; p < 0.001) was demonstrated as a predictive factor of 3-year recurrence, while sneezing (r = -0.25; p = 0.011), and operative time needed (r = -0.23; p = 0.016) did not reach statistical significance., Conclusions: Long-term symptomatic stability varies depending on the turbinoplasty method used. MAT demonstrated greater efficacy in controlling nasal symptoms, presenting better stability in reducing turbinate size and nasal symptoms. In contrast, radiofrequency techniques presented a higher rate of disease recurrence both symptomatically and endoscopically., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: To investigate the consistency between the international guidelines recommendations and worldwide standard practices regarding diagnostic work-up and follow-up strategies for managing patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the era of monoclonal antibodies., Methods: A questionnaire developed by the Rhinology section of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (Yo-IFOS) included items regarding the management of CRSwNP patients, monoclonal prescription, surgical and follow-up procedures, awareness of biologicals availability, and other relevant clinical practices. The online survey was directed to otolaryngologists and distributed in Europe, North America, South America, and the Middle East through otolaryngological and/or rhinological societies., Results: A total of 202 responses were analyzed; the mean participants' age was 45 ± 11 (73% men and 27% women), and 31% were from the United States, Canada 19%, Europe 45%, Middle East and South America 5%. Only 60% of the respondents declared using validated symptoms and endoscopic score systems in their clinical practice. Several practice discrepancies emerged in our cohort, including preferred surgical approach, prescription of preoperative oral steroids, and perioperative antibiotics (59% and 58%, respectively), as well as divergent awareness levels of available biologics for CRSwNP worldwide., Conclusions: CRSwNP needs a complex and time-consuming assessment, according to the latest guidelines. There seems to be a gap between these recommendations and the real-world data, which should draw more attention to bringing them into uniform clinical practice in the near future., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Refractory inferior turbinate hypertrophy requires a surgical approach to address symptomatic complaints. Submucosal approaches demonstrated their efficacy in restoring respiratory function and respecting the nasal mucosa. Microdebrider-assisted turbinoplasty (MAT) tools effectively reduces the soft tissue, exploiting a very different principle from the kinetic energy of radiofrequency. Thus, we aimed to compare the microdebrider-assisted turbinoplasty and the quantum molecular resonance (QMR) to assess patients' perspectives and respiratory outcomes., Methods: Subjects with persistent bilateral nasal blockage due to inferior turbinates hypertrophy were prospectively recruited from the University Medical Center. We randomly assigned the patients to each treatment and performed symptom evaluation via the visual analog score and endoscopic assessment at baseline and 30-, 90-, and 180-day post-treatment., Results: Seventy participants completed the evaluations, 35 in MAT and 35 in the QMR group. Nasal complaints were significantly reduced after 1 month using both methods. Although the MAT group reported higher postoperative bleeding and edema than QMR group, similar significant reductions were seen for turbinate size at long-term follow-up. Conversely, the MAT group reported greater VAS outcomes than QMR from the first postoperative month. In addition, MAT showed a longer operating time, although this difference was not statistically significant (p < 0.05)., Conclusion: MAT allows effective control of nasal symptoms by reducing the size of turbinates in patients with lower turbinate hypertrophy. Although QMR may cause fewer postoperative complications, functional results are comparable to long-term follow-up., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Odontogenic sinusitis and sinonasal complications of dental disease or treatment (SCDDT) represent a heterogeneous group of conditions that often require multidisciplinary care. The present study aims to prospectively validate a classification and treatment protocol for SCDDT patients., Methods: One hundred twenty-eight consecutive patients (73 females and 45 males, mean age 52.4 years) affected by SCDDT not responding to dental and medical therapy were classified and surgically treated according to the proposed protocol. The protocol classified patients into three aetiology-based groups (preimplantologic, implantologic, and related to traditional dental diseases and procedures, respectively). The groups were further divided into classes according to the presence of oro-antral communications and/or dislocated dental hardware. Each condition was treated according to the class-related, protocol-defined treatment, by either a transnasal or combined transnasal/transoral approach. All patients were successfully classified according to our protocol. None of the proposed classes were redundant, and no condition fell outside the definitions., Results: The surgical treatment protocol proved to be adequate and effective, in that 125 of the 128 patients completely recovered after surgical treatment., Conclusions: The term SCDDT and the consequent classification proposed by the authors appear, therefore, to be nosologically correct. Furthermore, the protocol-related proposed treatment appears to be clinically sound, with a success rate nearing 98%.

Headache secondary to sinonasal disease is still overestimated in the diagnostic pathway of cephalalgia. Contrary to belief, so-called sinus headaches are fairly uncommon and seen mostly in acute sinusitis or acute exacerbations. Even though literature has written extensively about the prevalence of migraines in self-diagnosed or primary care-diagnosed sinus headache, there is only a small body of literature regarding the real prevalence of pain and headache occurring during acute and chronic sinusitis.We reviewed the current literature and clarified the differences in presentation of pain for acute and chronic sinusitis, highlighting the higher prevalence of pain in chronic rhinosinusitis without polyps versus with polyps. Furthermore, we stressed the need for a rethinking in the clinical diagnosis of sinusitis based on pain as a major symptom.

Background: Nasal cytology at birth and in the pediatric age is barely investigated regarding its association with the onset of common pediatric diseases. Methods: We enrolled 241 newborns within their first 24 h of life, studying their nasal cellular composition and repeating this at 1 and 3 years of life. We collected anamneses of perinatal factors and external factors (parental smoking, passive smoking, breastfeeding), and the prevalence of otitis, rhinosinusitis, bronchitis, asthma, and allergy at all timepoints. Results: 204 children completed the study. At birth, there was a prevalence of ciliated cells and rare neutrophils. At 1 and 3 years, ciliated cells started reducing in favor of muciparous cells and neutrophils. We found that caesarian delivery and nasogastric tube usage for choanal patency are significantly related to a certain cellular nasal composition. Additionally, development of upper respiratory tract infections, AOM (acute otitis media) and allergy correlates with specific cytological compositions which may predict those pathologies. Conclusions: Our study is the first to show the normal nasal mucosa cellular composition and development in the first 3 years of life in a large cohort. Nasal cytology may be a tool for early risk assessment in the occurrence of upper airway disease. [ABSTRACT FROM AUTHOR]