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Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) remains challenging to manage effectively, with high symptom recurrence rates and significant impacts on quality of life, prompting a need to evaluate the real-world use of biologics and optimize treatment strategies., Objective: To assess the real-world application and perspectives of American Rhinologic Society (ARS) members on biologic treatments and surgical interventions for CRSwNP, focusing on clinical practice patterns, adoption of biologics, and their impact on surgical practices., Methods: A standardized questionnaire evaluated clinical practice patterns of biologics prescriptions and surgery in treating CRSwNP between July 2022 and August 2023. Data collected from 162 ARS members were analyzed., Results: Of 162 participants, a substantial majority (95.06%, n  = 154) reported prescribing biologics in their practice. Notably, 45.45% ( n  = 70) found biologics easily accessible, although accessibility challenges remained for some. The impact of biologics on surgical practices was significant, with 36.36% ( n  = 56) observing a marked reduction in revision sinus surgeries. Among the participants, 47.16% ( n  = 71) agreed that aspirin-exacerbated respiratory disease (AERD) was the highest phenotype that tended to increase the possibility of biological treatment by more than 20%. Adopting Patient-Reported Outcome Measures (PROMs) was prevalent, with 57.79% ( n  = 89) utilizing them in patient management., Conclusion: The study highlights the evolving landscape in managing CRSwNP, with a marked trend toward integrating biological treatments into clinical practice. It underscores the necessity for continued research, updates to clinical guidelines, and enhanced practitioner education to optimize treatment outcomes for CRSwNP patients., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Sinonasal non-intestinal-type adenocarcinomas represent a rare subset of head and neck cancers with distinct pathological and clinical characteristics. Patients usually present with nasal obstruction, epistaxis, and rhinorrhea. The diagnosis is established through histopathological examination. The treatment of choice is complete surgical excision with or without radiotherapy. We report a case of low-grade non-intestinal type sinonasal adenocarcinoma in a 65-year-old male patient. Nasal endoscopy showed a left-sided grade 4 polyp based on Meltzer classification, which is attached to the left middle turbinate. Computed tomography of the paranasal sinuses showed a polyp in the superior part of the left nasal cavity compressing the left middle turbinate with obliteration of the left sphenoethmoidal recess. Initial biopsy results were inconclusive, and the patient underwent complete surgical excision of the mass along with anterior and posterior ethmoidectomy. Excisional biopsy results showed strong positivity for SOX10, S100, and DOG1, indicating seromucinous differentiation. Six months post-operatively, the patient is doing well with no clinical or radiological signs of recurrence. In conclusion, this case underscores the importance of timely diagnosis and comprehensive surgical intervention in managing low-grade non-intestinal type sinonasal adenocarcinomas, ultimately contributing to improved patient outcomes and highlighting the need for further research in this rare cancer subtype., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alfadley et al.)

Background: To assess the risk of depression in patients with chronic rhinosinusitis (CRS) in a tertiary care center and the effect of treatment on depression scores., Methods: This prospective cohort study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between November 2021 and June 2022 and included adult patients (≥14 years) with CRS. The validated Arabic or English Sinonasal Outcome Test (SNOT-22) and Patient Health Questionnaire-9 (PHQ-9) were used before treatment and 3 to 6 months after surgery and maximal medical treatment. PHQ-9 scores were compared at baseline and follow-up visits. The relationship between changes in SNOT-22 and PHQ-9 scores were assessed using Spearman's correlation and simple linear regression., Results: Overall, 38 participants with a mean ± SD age of 32.7 ± 12 years were enrolled. CRS with nasal polyps (55.26%) was the most frequently seen condition, followed by allergic fungal CRS (31.58%) and CRS without nasal polyps (13.16%). Six patients (15.7%) had PHQ-9 scores ≥10, indicating they had major depressive disorder. PHQ-9 and SNOT-22 scores improved significantly after treatment (3.7 ± 5.8 vs 6.5 ± 6.9 pretreatment, P  = .001; 20.7 ± 20.5 vs 45.6 ± 28.9 pretreatment, P  < .0001, respectively). Mean ± SD change in PHQ-9 and SNOT-22 scores was -2.7 ± 7 and -24.9 ± 29.8, respectively. SNOT-22 and PHQ-9 scores were positively correlated ( r  = .522, P  < .001). PHQ-9 score change was significantly associated with SNOT-22 score change (β = .178, 95% confidence interval 0.12-0.23, P  < .0001)., Conclusion: CRS affects the quality of life and psychological well-being of patients. Patient-centered care with maximal medical and surgical treatment help overcome its deleterious consequences., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic noninvasive sinusitis accounting for 7.8% (0.2%-26.7%) of all chronic rhinosinusitis cases. A definitive diagnosis is usually made after sinus surgery. Successful treatment requires a combination of surgical and medical management. Although orbital involvement is relatively common, reports on optic neuropathy and acute vision loss are limited. Herein, we present a series of 3 patients with AFRS who presented with acute visual loss as the chief complaint. All 3 patients were otherwise healthy adults in their early 20s with extensive nasal polyps on endoscopic nasal examination and bone erosion in the bilateral orbits and lateral wall of the sphenoid sinus on the affected side on imaging. One of the 3 patients had bilateral cranial nerve IV defects in addition to cranial nerve III defects. All patients underwent endoscopic sinus surgery with orbital decompression and were followed up postoperatively by both otolaryngology and ophthalmology services with endoscopic and radiologic evaluation. Unfortunately, no meaningful improvement in vision was observed in any patient despite successful nerve decompression. Prompt diagnosis and early medical and surgical intervention are warranted to prevent complications in patients with AFRS with orbital extension., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Introduction and Importance: Foreign bodies in paranasal sinuses are rarely encountered and most commonly present in the maxillary sinus. Guidelines for managing paranasal sinus object removal are limited due to its rarity. However, there are three major management options: open surgery, endoscopic sinus surgery, and observation., Case Presentation: We report a rare case of an 18-year-old boy who underwent extended frontal sinus surgery to retrieve a retained air gun pellet in the right frontal sinus and repair the skull base defect resulting from the air gun pellet., Clinical Discussion: Physicians commonly use endoscopic sinus surgery (ESS) for improving sinus drainage in recurrent chronic and acute infective sinusitis. Extended sinus surgery aims to maximize the communication between the paranasal sinuses and the nasal cavity. This extended communication helps improve access to the sinus, enhance drainage, and improve the delivery of topical medications. In addition, the use of ESS with the modified Lothrop procedure allows for better exposure of the skull base, which can help with the repair of a CSF leak., Conclusion: Based on our experience with this patient and similar literature, ESS should be considered a treatment option for patients with retained foreign objects in the frontal sinus., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Meningoceles are defined as herniation of the meninges through a skull base defect. If brain tissue is herniated as well, then it is called meningoencephalocele. The most common locations of meningoceles are the cribriform plate and the lateral recess of the sphenoid sinus, with the most common presentation being CSF leakage. We present a case of temporal lobe meningocele that herniated through a defect in the greater wing of the sphenoid bone to the pterygoid fossa and that was diagnosed incidentally while evaluating the patient for seizures., Methodology: Case report and literature review., Conclusion: The endonasal endoscopic approach is a suitable minimally invasive approach for the management of pterygoid fossa lesions, including meningoceles. In this case, the patient had epilepsy with the surgery resulting in the resolution of the seizures., (Copyright © 2021. Published by Elsevier Ltd.)

Introduction and Importance: Seromucinous hamartoma is a rare benign glandular proliferation arising from the respiratory epithelium, which was originally described by Baillie and Batsakis in 1974. Since this time, case reports started to be published on SH, as a middle aged and elderly disease, here we report a case of a pediatric patient who found to have SH., Presentation of the Case: 2-year-old girl, brought by her parent with a complain of a mass at the right medial canthal area for one year., Clinical Discussion: As this pediatric patient presented with long standing history of right medial canthal area, we made out differential diagnosis list, with keeping congenital midline nasal masses such as nasal glioma, dermoid, and encephalocele at the top of our differentials, followed by inflammatory disease and lacreimal system disease. After bedside clinical assessment and imaging, patient underwent endoscopic sinus surgery for surgical excision, histopathology analysis came as Seromucinous hamartoma. Postoperative course was unremarkable, patient is disease- free for 18 months, till her most recent follow up. With no additional treatment or recurrence., Conclusion: This case report indicates that seromucinous hamartoma should always be considered in the differential diagnosis of pediatric sinonasal disease. According to the literature review we did; this is the first case reported in such an age group., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Various graft materials that are classified as autografts, xenografts, and allografts based on their origin have been used to endoscopically repair skull base defects. Tutoplast® (Tutogen Medical GmbH), an allogeneic natural collagen matrix, is processed through chemical sterilization that preserves tissue biocompatibility and structural integrity., Objective: To study the safety and efficacy of Tutoplast Fascia Lata and Tutoplast Temporalis Fascia® as primary graft materials in the endoscopic reconstruction of skull base defects of different sizes and etiologies and to compare the outcomes with those of other traditional graft materials based on our experience., Methods: This is a multi-center retrospective chart review of patients who underwent cerebrospinal fluid leak (CSF) endoscopic reconstruction with Tutoplast Fascia Lata or Tutoplast Temporalis Fascia as either a stand-alone reconstruction material or a part of a multilayer reconstruction depending on the defect at Prince Sultan Military Medical City and King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia, between 2017 and 2020. Our inclusion criteria were CSF leak repair with Tutoplast and a transnasal endoscopic approach. We reviewed demographic data, intraoperative and postoperative complications, repair materials, repair failure, defect size and location., Results: Tutoplast® was used as the primary graft material in 33 cases. Our main outcome was repair success with lack of post operative CSF leak, observed in 30 cases (90.9%). There was no significant association between postoperative CSF leaks and factors including different defect sizes, defect sites, demographic data, hospitalization duration, or postoperative radiation in oncological cases., Conclusion: Tutoplast alone or in combination with other materials can be used safely and effectively for skull base defects repair., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background and objective Quality of life measurement is an essential element of healthcare evaluation. The Sino-Nasal Outcome Test 22 (SNOT-22) has been validated in different languages, and in this study we validated the SNOT-22 in Arabic language. The objective of this study is to provide a validated, cross-culturally adapted version of the SNOT-22 for the Arabic speaking population. Materials, methods, and main outcome measures This was a prospective cohort study set in a tertiary hospital in Riyadh, Saudi Arabia. The SNOT-22 was translated into Arabic by two native Arabic speakers. A total of 30 patients with chronic rhinosinusitis (CRS) with/without nasal polyps were included in test-retest study. Following that, a prospective study was conducted where the translated SNOT-22 was distributed to a different set of 30 CRS patients before and three months after endoscopic sinus surgery. Another 50 healthy individuals were included as a control group. The main outcome measure was the translation and validation of the SNOT-22 in Arabic. Results Internal consistency was assessed by performing a test-retest study. Cronbach's alpha was 0.803 at both the initial examination and at the retest, showing good internal consistency. There was a statistically significant difference between the results of the control group and the preoperative results of the CRS group (p<.001). The preoperative mean (SD) SNOT-22 score for the CRS group was 64.8 (20.3) and it dropped to 29.2 (11.8) postoperatively showing statistically significant change (p<.001), indicating the responsiveness of the SNOT-22. Conclusion The Arabic version of the SNOT-22 has internal consistency, reliability, and reproducibility that is needed for it to be a valid instrument to be used in research and clinical practice., Competing Interests: The authors have declared that no competing interests exist.

The transnasal endoscopic resection of ventral skull base lesions represents a safe and effective method for the surgical management of sinonasal and ventral skull base malignancies in carefully selected cases. The goal of surgery is complete removal of all tumor with negative resection margins while maintaining the key oncological principles. Careful selection of cases along with the presence of an experienced surgeon and a fully involved multidisciplinary skull base team trained in the management of ventral skull base neoplasm are essential for excellent outcomes., (Copyright © 2016 Elsevier Inc. All rights reserved.)