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Purpose: Antibody therapy for chronic rhinosinusitis with nasal polyps (CRSwNP) has been established in Germany since 2019. With limited long-term data on biologic treatment for CRSwNP, we conducted a comprehensive evaluation of our 4-year data. This monocentric study aims to assess the real-world effects of this treatment on clinical course, quality of life, treatment adherence, biologic switching, dual therapy, and comorbidities., Methods: We retrospectively analysed biologic therapy data in patients with severe chronic rhinosinusitis with nasal polyps. 191 patients with CRSwNP treated with Dupilumab, Mepolizumab, or Omalizumab were observed for up to 4 years in a real-life setting., Results: We observed clear symptom improvements with few side effects. No loss of efficacy or tolerability was noted during the 4-year period. Patients reported high satisfaction compared to previous therapies, with overall improved quality of life. Revision surgery or oral steroid use during biologic therapy was rare. Some patients prolonged injection intervals or discontinued steroid nasal spray. Biologic switching occurred infrequently due to side effects or inadequate response and was generally well tolerated. Many patients reported additional positive effects such as asthma or allergy symptom improvement and reduced medication intake., Conclusion: In summary, this study confirms the potency and tolerability of biologics for CRSwNP treatment, with sustained efficacy over 4 years. Biologic switching is a viable option for inadequate response or intolerable side effects. Therapy positively impacts Th2 comorbidities, corticosteroid requirements, surgery need, and overall compliance remains high., Clinical Trial Registration: Project No.: 22-0802. Registry name: Biologika bei Patient*innen mit chronischer Sinusitis mit Nasenpolypen., (© 2024. The Author(s).)

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease, the treatment of which has undergone significant changes in recent years. In addition to surgical approaches, topical and systemic steroids, and adaptive acetylsalicylic acid (ASA) desensitization, three specific antibodies have complemented the therapeutic portfolio since 2019., Methods: A retrospective evaluation of all patients who presented as outpatients for the first time due to CRSwNP in 2007 and 2008 (collective A) and 2017 and 2018 (collective B) was performed, up to and including June 2023., Results: The clinical courses of 463 patients (mean age 49.1 years, range 5-82 years; 65.9% male) were included in the analysis. Conservative treatment with nasal corticosteroids started before initial presentation was more frequent in collective B (collective A 43.9% vs. collective B 72.2%). In 278 of the 463 patients (60%; A: 62%, B: 58%), at least one operation on the nasal sinuses had been performed after initial presentation; in 101 of these patients (36.3%) recurrent polyposis (within mean follow-up of 2.4 years) required further treatment. The indication for ASA provocation/desensitization was applied less frequently in collective B, also due to a high discontinuation rate (at least 38%) of the maintenance therapy. Of the total cohort, 16 patients (3.5%; A: n = 8, B: n = 8) were meanwhile switched to antibody therapy at recurrence., Conclusion: A step-by-step guideline-orientated approach is recommended in the treatment of CRSwNP. Systemic antibodies as an add-on to nasal corticosteroids are a relatively new therapeutic option for treatment-refractory CRSwNP, which reduces the indication for ASA desensitization, which is associated with a relatively high incidence of side effects and poor compliance., (© 2024. The Author(s).)

Objectives: To qualitatively explore patient experiences of severe, recurrent, bilateral nasal polyps (NP)., Methods: A targeted literature review of published qualitative studies and online blogs describing patient experiences of NP was conducted. Semistructured concept elicitation interviews were conducted in the United States and Germany with participants ≥18 years with severe, recurrent, bilateral NP to explore their symptom experience and impacts on health-related quality of life (HRQoL; NCT03221192). A subset of 10 participants reported symptoms and impacts using a smartphone or tablet application (app) over a 10-day period., Results: A paucity of qualitative evidence regarding patient experience of NP was identified from the literature or blog review. Twenty-seven participant interviews were conducted. Thirty-six symptoms were identified, including 7 primary symptoms (nasal congestion [n = 27 of 27], breathing difficulties [n = 27 of 27], postnasal drip [n = 25 of 27], runny nose [n = 24 of 27], head/facial pressure [n = 23 of 27], loss of smell [n = 23 of 27], loss of taste [n = 22 of 27]) and 29 secondary symptoms (the most common were mucus/catarrh and nose bleeds [both n = 20 of 27]). Most symptoms were reported to vary both within and between days. Sixty impacts of severe NP were reported, including impacts on sleep (n = 22 of 27), physical functioning (n = 21 of 27), activities of daily living (n = 21 of 27), emotional well-being (n = 27 of 27), treatment (n = 23 of 27), social life (n = 26 of 27), and work (n = 19 of 27). Symptoms/impacts reported using the app were consistent with interview findings, although new symptoms were identified (ear pain, throat pain, nasal scabs, and nasal burning). These results supported the development of a conceptual model outlining concepts related to symptoms, impacts, and treatment of NP., Conclusions: Severe, recurrent, bilateral NP are associated with a range of symptoms that have significant detrimental impact on HRQoL., (Copyright © 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Background: The aim of the present study was to provide an insight into medical treatment practices among patients with chronic rhinosinusitis (CRS) in Germany. An investigation of ICD codes and ATC classes of CRS patients in general and otolaryngology offices in Germany should reveal the prevalent treatment behaviors of German physicians., Methods: The present study used data from the Disease Analyzer database (IQVIA). The study sample included patients from 940 general (GP) and 106 otolaryngology (ENT) practices who were coded as having chronic sinusitis (ICD-10: J32) or nasal polyps (ICD-10: J33) in 2015 (index date). The primary outcome measures were the number of patients with these diagnoses per practice as well as the proportion of patients with prescriptions for topical corticosteroids, systemic corticosteroids, antibiotics, antihistamines, and local decongestants within 365 days after the first diagnosis., Results: This retrospective study included 26,768 patients with coding for chronic sinusitis (ICD-10: J32) and 516 patients for nasal polyps (ICD-10: J33) in 940 GP practices and 19,826 patients with coding for chronic sinusitis (ICD-10: J32) and 1,773 patients for nasal polyps (ICD-10: J33) in 106 ENT practices. In patients coded as having chronic sinusitis (ICD-10: J32), topical corticosteroids were prescribed at a low rate (GP: 12.3%, ENT: 34.3%). In patients coded as having nasal polyps (ICD-10: J33), topical corticosteroid usage was higher in GP practices (27.3%) and in ENT practices (71.2%)., Conclusions: Topical corticosteroid usage in CRS patients in GP practices in Germany is as low as in other Western countries. Increased usage of topical corticosteroids in CRS patients with polyposis should be encouraged in GP and ENT practices.

Aim: The Nasal Spray Evaluation Questionnaire is a standardized means to evaluate hedonicity of nasal sprays in the English speaking countries. To date, there is no such questionnaire for German speaking patients. The here presented study aimed at evaluating the translated questionnaire. Three nasal sprays were tested and the questionnaire was used to estimate sensory hedonicity. Finally, the questionnaire was improved and can now serve as a standardized means to measure nasal sensory perceptions., Material and Methods: The questionnaire was literally translated from English to German. There were three groups of 60 patients each presenting with the sensation of a 'dry nose' to a secondary medical center with a board certified otolaryngologist. The ingredients of the three different nasal sprays varied only in one phytotherapeutic addition. The first evaluation of the nasal spray was conducted immediately after application of the nasal spray, and two minutes after application. A third and optional telephone survey was performed several days later after continuous use of the spray., Results: The different evaluations of nasal sprays were already lined out after the first questionnaire. It could serve as a new, reliable and reproduceable tool for the evaluation of nasal sensory perceptions., Discussion: The questionnaire served as an adequate tool to estimate hedonicity of nasal sprays. First results of the German version show, however, that it could facilitate the evaluation by restructuring the questionnaire. Continuously marking good grades with high points (maximum 100) and negative answers with low points (minimum 0 points) will unify and simplify the questionnaire., Conclusion: The translation of the Nasal Spray Evaluation Questionnaire into a German version can serve as a new standard tool for measuring nasal sensation., (Georg Thieme Verlag KG Stuttgart * New York.)

Background: Homeopathy is a highly debated but often used medical treatment. With this cohort study we aimed to evaluate health status changes under homeopathic treatment in routine care. Here we extend former results, now presenting data of an 8-year follow-up., Methods: In a prospective, multicentre cohort study with 103 homeopathic primary care practices in Germany and Switzerland, data from all patients (age >1 year) consulting the physician for the first time were observed. The main outcome measures were: The patients' perceived change in complaint severity (numeric rating scales from 0 = no complaint to 10 = maximal severity) and quality of life as measured by the SF-36 at baseline, and after 2 and 8 years., Results: A total of 3,709 patients were studied, 73% (2,722 adults, 72.8% female, age at baseline 41.0 +/- 12.3; 819 children, 48.4% female, age 6.5 +/- 4.0) contributed data to the 8-year follow-up. The most frequent diagnoses were allergic rhinitis and headache in adults, and atopic dermatitis and multiple recurrent infections in children. Disease severity decreased significantly (p < 0.001) between baseline, 2 and 8 years (adults from 6.2 +/- 1.7 to 2.9 +/- 2.2 and 2.7 +/- 2.1; children from 6.1 +/- 1.8 to 2.1 +/- 2.0 and 1.7 +/- 1.9). Physical and mental quality of life sores also increased considerably. Younger age, female gender and more severe disease at baseline were factors predictive of better therapeutic success., Conclusion: Patients who seek homeopathic treatment are likely to improve considerably. These effects persist for as long as 8 years.

Apart from allergen avoidance, specific immunotherapy (SIT) represents the only potentially curative treatment available to patients with allergic rhinoconjunctivitis. Evidence for its clinical efficacy has been clearly demonstrated in several controlled clinical trials and depends on the allergen to which the patient is sensitive, the quality and total amount of allergen administered, and the SIT schedule. In classic SIT, gradually ascending dosages of the allergen extract are injected subcutaneously (dose-increase period) until the individual maximum dose is reached (dose-maintenance period). Several dosage schedules have been worked out. In cluster immunotherapy, 2-3 injections per day of treatment are given once a week to rapidly reach the maintenance dose. Several cluster schedules have been described. Recent data demonstrate that the frequency and severity of adverse effects in cluster immunotherapy correspond to those in other dosage schedules. As far as safety goes, cluster immunotherapy is an interesting alternative for the dose-increase period. In addition, recent studies reveal that clinical benefits appear sooner with cluster immunotherapy.

Background and Objective: Bacterial rhinosinusitis is one of the most frequent indications for an antibiotic therapy. The objective of this study was the analysis of the current pathogen spectrum and its antimicrobial susceptibility., Material and Methods: Between 1999 and 2004, 188 specimens obtained from 170 patients with acute, purulent rhinosinusitis were analysed., Results: A total of 217 pathogens were isolated. The most common isolates were Streptococcus pneumoniae (33%), Haemophilus influenzae (27%), Staphylococcus aureus (13%), Moraxella catarrhalis (11%) and streptococci (7%). S. pneumoniae, H. influenzae and M. catarrhalis were the predominant pathogens in children. S. pneumoniae, S. aureus and streptococci, however, dominated in specimens from adults., Conclusion: Based on these results, adults should be treated with an aminopenicillin with beta-lactamase inhibitor or a cephalosporin of the second generation. For children , however, the first line antibiotic is an aminopenicillin.