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Objectives: Despite longstanding clinical gestalt of a relationship between rhinitis and Eustachian tube dysfunction (ETD), population-level evidence supporting this connection is lacking, particularly among adolescents. We aimed to investigate the association between rhinitis and ETD in a nationally-representative sample of United States adolescents., Methods: We performed cross-sectional analyses of 2005-2006 National Health and Nutrition Examination Survey data (n = 1955, ages 12-19). Rhinitis (self-reported hay fever and/or nasal symptoms in the past 12 months) was stratified as allergic (AR) or nonallergic rhinitis (NAR) based on serum IgE aeroallergen positivity. History of ear disease and procedures was recorded. Tympanometry was classified by type (A, B, C). Multivariable logistic regression was used to test the association of rhinitis and ETD., Results: Among US adolescents, 29.4% reported rhinitis (NAR 38.9%, AR 61.1%), and 14.0% had abnormal tympanometry. Adolescents with rhinitis were more likely to report a history of ≥3 ear infections (NAR: OR 2.40, 95% CI: 1.72-3.34, p < 0.001; AR: OR 1.89, 95% CI: 1.21-2.95, p = 0.008) and tympanostomy tube placement (NAR: OR 3.53, 95% CI: 2.07-6.03, p < 0.001; AR: OR 1.91, 95% CI: 1.24-2.94, p = 0.006), compared to those without rhinitis. There was no association between rhinitis and abnormal tympanometry (NAR: p = 0.357; AR: p = 0.625)., Conclusion: NAR and AR are both associated with history of frequent ear infections and tympanostomy tube placement in US adolescents, supporting an association with ETD. This association is strongest for NAR, suggesting that specific inflammatory mechanisms may be involved in this condition and potentially explaining why traditional therapies for AR are largely ineffective for ETD., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

A growing body of epidemiological data indicates that the prevalence and public health burden of asthma and other common allergic conditions (eg, atopic dermatitis, food allergy, allergic rhinitis, and drug allergy) is greatest among certain historically marginalized populations. However, these historically marginalized populations are often under-represented in research aiming to better understand, treat, and prevent these chronic conditions, raising concerns about the generalizability of the resulting study findings to those who are most affected. In a country as heterogeneous as the United States, with respect to race and ethnicity, socioeconomic status, culture, geography, and behavior, researchers aiming to characterize the burden of allergic disease, evaluate treatments, and/or better understand its mechanisms must pay particular attention to whether their samples are sufficiently diverse and representative in order to maximize the validity-and scientific utility-of the resulting data. Therefore, the goal of this clinical commentary is to highlight the need for improved, more thoughtful representation of the full diversity of affected populations in allergy/immunology research and share best practices for study design, recruitment, retention, and data analysis, so that both the research process and products can have maximal public health impact., (Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: The use of preoperative systemic steroids (PSS) in endoscopic sinus surgery (ESS) has been a topic of debate among otolaryngologists for many years now. Until recently, most of the evidence to support PSS use in ESS was largely anecdotal and based on expert opinion. Although some recent randomized and blinded trials have been published, opinions among experts in the field are highly variable. The objective of this study is to identify and report the practice patterns of experts in the field regarding the use of PSS., Methods: A survey instrument was developed using SurveyMonkey® and sent to active members of the American Rhinologic Society (ARS). Responses to questions regarding PSS use, regimen, and benefits were recorded anonymously., Results: A total of 173 members answered the questionnaire. Although most respondents believe that there is inadequate evidence to support their use, 88.82% of the study population does use PSS in their practice. The most common diagnosis among respondents for using PSS is chronic rhinosinusitis with polyps (CRSwNP), which is consistent with the literature available. We also found statistically significant differences between PSS use in private vs academic practice, showing a trend toward more aggressive management in academic-affiliated physicians., Conclusion: The current study shows that most of the respondents in our group do in fact see an advantage in the use of PSS before ESS. The data also highlights the opinion of most experts that more research with higher levels of evidence is still lacking., (© 2012 ARS-AAOA, LLC.)

Background: Research demonstrates significant health care cost savings conferred by allergen-specific immunotherapy (AIT) to US children with allergic rhinitis (AR)., Objective: We sought to examine whether AIT-related cost benefits conferred to US children with AR similarly extend to adults., Methods: A retrospective (1997-2009) Florida Medicaid claims analysis compared mean 18-month health care costs of patients with newly diagnosed AR who received de novo AIT and were continuously enrolled for 18 months or more versus matched control subjects not receiving AIT. Analyses were conducted for the total sample and separately for adults (age≥18 years) and children (age<18 years)., Results: Matched were 4,967 patients receiving AIT (1,319 adults and 3,648 children) and 19,278 control subjects (4,815 adults and 14,463 children). AIT-treated enrollees incurred 38% ($6,637 vs $10,644, P<.0001) lower mean 18-month total health care costs than matched control subjects, with significant savings observed within 3 months of AIT initiation. Compared with control subjects, significantly lower 18-month mean health care costs were demonstrated overall (38%; $6,637 for patients receiving AIT vs $10,644 for control subjects, P<.0001), and for both AIT-treated adults (30%; $10,457 AIT vs $14,854 controls, P<.0001) and children (42%; $5,253 AIT vs $9,118 controls, P<.0001). The magnitude of 18-month health care cost savings realized by AIT-treated adults and children did not significantly differ ($4,397 vs $3,965, P=.435)., Conclusions: Patients with newly diagnosed AR initiating AIT incurred significantly lower health care costs than matched control subjects beginning 3 months after AIT initiation and continuing throughout the 18-month follow-up period. The significant cost benefits achieved by children with AR diagnoses who initiated AIT were also observed for adults with AR diagnoses who initiated AIT., (Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.)