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Background: No studies have investigated the systemic and local sinonasal profile of obesity‐related chronic rhinosinusitis (CRS), despite its observed association in recent retrospective studies. The objectives of our study were to assess the impact of obesity on the clinical and cytokine profile of patients with CRS and evaluate treatment response with functional endoscopic sinus surgery. Methods: This was a prospective observational study at the Cleveland Clinic that included patients with CRS (n = 54) between December 2021 and September 2022. Data collection included demographics, body mass index (BMI), comorbidities, baseline sinonasal outcome test scores, baseline radiologic scores (Lund–Mackay), postoperative sinonasal outcome test scores (at 3–4 months), and local and systemic alarmins/T‐helper cytokines. Results: Out of the 54 CRS patients, there were 20 CRS patients without nasal polyps (37%) and 34 with nasal polyps (63%). Patients were categorized based on obesity (BMI ≥ 30 kg/m2). Obese CRS patients had lower systemic alarmins (interleukin [IL]‐33 and Thymic stromal lymphopoietin (TSLP)) compared to non‐obese CRS patients (IL‐33: 744.2 ± 1164.6 pg/mL vs. 137.5 ± 320.0 pg/mL, p = 0.005; TSLP: 627.7 ± 1806.3 pg/mL vs. 28.1 ± 85.4 pg/mL, p = 0.017). CRS patients with nasal polyps with BMI ≥30 kg/m2 had higher postoperative sinonasal outcome test scores and lower levels of nasal eotaxin‐3 and IL‐33 compared to BMI <30 kg/m2 counterparts. Conclusions: In conclusion, patients with obese CRS and nasal polyps displayed diminished levels of intranasal alarmins and reduced intranasal eotaxin‐3. These results potentially imply the presence of a unique, obese type 2‐low CRS phenotype that warrants further exploration. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to investigate the utilization of artificial neural networks (ANNs) in learning models that address the nonlinear anisotropic flow and hysteresis retention behavior of deformable porous materials. Herein, the micro‐geometries of various networks of porous Bentheimer Sandstones subjected to several degrees of strain from the literature are considered. For the generation of the database required for the training, validation, and testing of the machine learning (ML) models, single‐phase and biphasic lattice Boltzmann (LB) simulations are performed. The anisotropic nature of the intrinsic permeability is investigated for the single‐phase LB simulations. Thereafter, the database contains the computed average fluid velocities versus the pressure gradients. In this database, the range of applied fluid pressure gradients includes Darcy as well as non‐Darcy flows. The generated output from the single‐phase flow simulations is implemented in a feed‐forward neural network, representing a path‐independent informed graph‐based model. Concerning the two‐phase LB simulations, the Shan‐Chen multiphase LB model is used to generate the retention curves of the cyclic drying/wetting processes in the deformed porous networks. Consequently, two different ML path‐dependent approaches, that is, 1D convolutional neural network and the recurrent neural network, are used to model the biphasic flow through the deformable porous materials. A comparison in terms of accuracy and speed of training between the two approaches is presented. Conclusively, the outcomes of the papers show the capability of the ML models in representing constitutive relations for permeability and hysteretic retention curves accurately and efficiently. [ABSTRACT FROM AUTHOR]

The following proceeding presents a multiscale approach to investigate the hydraulic anisotropy and retention behavior in porous materials involving deformation effects. Concerning the former, single‐phasic fluid flow simulations using the lattice Boltzmann method (LBM) are initially accomplished at the pore‐level geometry of Bentheimer sandstones provided by X‐ray microscopy at several degrees of compression to compute the intrinsic permeability. Due to the anisotropic nature of the Bentheimer sandstones, favored pore channels for fluid flow are witnessed within the domain. Therefore, it is important to understand the alteration of the preferred flow paths at each degree of compression. In this regard, we propose a new upscaling approach between the LBM and the macroscopic Theory of Porous Media (TPM) to accurately compute the macroscopic hydraulic structural tensor, which plays a crucial role in the calculation of the deformation‐dependent anisotropic specific permeability. As for the latter, the Shan‐Chen (SC) model of the LBM is applied at each strain level to model biphasic fluid flow via the unsaturated porous domain. Herein, the retention curves of the drainage and imbibition processes of each deformed state are computed. In turn, the comparison among the results shows the effect of variation of the strain degree on the retention behavior. [ABSTRACT FROM AUTHOR]

In this paper, we present a reliable micro‐to‐macroscale framework to model multiphase fluid flow through fractured porous media. This is based on utilizing the capabilities of the lattice Boltzmann method (LBM) within the phase‐field modeling (PFM) of fractures in multiphase porous media. In this, we propose new physically motivated phase‐field‐dependent relationships for the residual saturation, the intrinsic as well as relative permeabilities. In addition, an anisotropic, phase‐field‐dependent intrinsic permeability tensor for the fractured porous domains is formulated, which relies on the single‐ and multiphasic LBM flow simulations. Based on these results, new relationships for the variation of the macroscopic theory of porous media (TPM)–PFM model parameters in the transition zone are proposed. Whereby, a multiscale concept for the coupling between the multiphasic flow through the crack on one hand and the porous ambient, on the other hand, is achieved. The hybrid model is numerically applied on a real microgeometry of fractured porous media, extracted via X‐ray microcomputed tomography data of fractured Berea Sandstone. Moreover, the model is utilized for the calculation of the fluid leak‐off from the crack to the intact zones. Additionally, the effects of the depth of the transition zone and the orientation of the crack channels on the amount of leakage flow rates are studied. The outcomes of the numerical model proved the reliability of the multiscale model to simulate multiphasic fluid flow through fractured porous media. [ABSTRACT FROM AUTHOR]

Background: Studies have not yet examined the trends and risk factors of biphasic and recurrent anaphylaxis in the United States using International Classification of Diseases, tenth revision (ICD‐10) CM codes. The goal of this study is to examine the trends of biphasic and recurrent anaphylaxis in all patient care settings (inpatient, outpatient, emergency department, and observation). Methods: We used the Clinformatics database from 2015 to 2017. Our main outcome measure was recurrent anaphylactic events occurring within 1 year after the initial event. We used Cox proportional hazards modeling to assess the factors associated with recurrent anaphylaxis and the Kaplan‐Meier method to estimate time to recurrence. Results: There were a total of 19,039 patients with incident anaphylaxis in 2016 and, of these, 2017 had a recurrent anaphylaxis event in the 12‐month period after the index date (10.6%). The most common trigger for recurrent anaphylaxis is venom followed by food allergens. Pediatric patients aged <18 years were more likely to develop recurrent anaphylaxis compared with patients aged 18 to 64 years (hazard ratio [HR], 1.53). Patients with allergic rhinitis and asthma were more likely to develop recurrent anaphylaxis compared to those without these comorbidities (HR, 1.15 and 1.27, respectively). Conclusion: This is the first national study using ICD‐10 CM codes looking at rates of biphasic and recurrent anaphylaxis in all patient care settings. Recurrent anaphylaxis is more common in the first 3 days after the initial event, in younger patients (<18 years), and in patients with allergic rhinitis and/or asthma. Physicians need to prescribe epinephrine auto‐injectors and educate their patients about the risk of recurrence. [ABSTRACT FROM AUTHOR]

Background: No national study has examined the epidemiology of anaphylaxis after introduction of the codes of the International Statistical Classification of Diseases and Health Related Problems, Tenth Revision, Clinical Modification (ICD‐10 CM). Our objective was to examine the trends in incidence and hospitalization rates in the United States utilizing ICD‐9 and ICD‐10 CM codes. Methods: We used the Clinformatics database from 2004 to 2016. Our outcome measures included incidence of anaphylaxis and hospitalization trends. Multivariable logistic regression was used to assess the predictors of anaphylaxis and hospitalization. Results: There were a total of 462,906 anaphylaxis cases. The incidence increased from 153 in 2004 to 218 in 2016 (per 100,000). Women were 1.19 (95% confidence interval, 1.18‐1.20) times more likely to present with anaphylaxis. Medication‐induced anaphylaxis increased 15‐fold. Conclusion: This is the first population‐based study that included ICD‐10 CM codes to describe the epidemiology of anaphylaxis in the United States. ICD‐10 codes improved the accuracy of medication‐induced anaphylaxis, the most likely etiology to result in hospitalization. [ABSTRACT FROM AUTHOR]

Objective: Our objective is to determine the risk factors associated with recurrent epistaxis requiring emergency department (ED) visits in the elderly.Methods: We used a 5% national sample of Medicare data from January 2012 through December 2013. Our cohort included patients with a new diagnosis of epistaxis in the ED, defined as no epistaxis in the prior 12 months. We assessed the rates of ED visits for recurrent epistaxis in the 12 months following the incident visit. Our variables included demographics, geographic location, procedures performed during the incident visit and comorbidities.Results: Out of the 4120 patients with incident epistaxis, 775 were readmitted with recurrent epistaxis within 12 months. 60% presented in the first 30days and 75% within 90 days. There was a significant increase in ED visits for patients over 75 years of age and in men compared to women. Recurrent ED visits for epistaxis was higher in patients with congestive heart failure, diabetes mellitus, and obstructive sleep apnea compared to those without these comorbidities.Conclusion: Additional ED visits for epistaxis are more common in the elderly and in males. Congestive heart failure, diabetes mellitus and obstructive sleep apnea were found to be independent risk factors. [ABSTRACT FROM AUTHOR]

In this contribution, the Shan‐Chen (SC) two‐phase flow model of the lattice Boltzmann method (LBM) is numerically implemented to simulate multiphase fluid flow on microtomography (µ‐CT) data of a sphere packing. From the model, the saturation degrees of the fluid phases, i.e. invading and displaced fluids, are extracted from the computed lattice density distribution functions. Several simulations are run with different degrees of kinetic viscosity contrast between the fluid phases within increasing increments of capillary pressure. At each increment, the relative permeability regarding each fluid phase is computed as a function of the saturation degree. The motivation of this study is to (1) investigate the effect of the kinetic viscosity contrast between the fluid phases on the retention behavior, (2) analyze the range of validity of the van Genuchten relation according to the computed retention data and (3) propose an extension towards an upscaling micro‐to‐macroscopic hierarchic scheme for the simulation of multiphasic fluid flow in unsaturated porous media. [ABSTRACT FROM AUTHOR]

Background Over the past decade, the use of balloon sinuplasty has increased widely in the United States. Since its introduction, no nationally representative, population-based study has examined its use among chronic rhinosinusitis (CRS) patients. Methods We conducted a retrospective cohort study of patients diagnosed with CRS between 2011 and 2014, and compared the prevalence of conventional functional endoscopic sinus surgery (FESS), balloon sinuplasty, and hybrid sinus surgery according to surgical site and calendar year. Results Out of 11 million to 11.4 million enrollees per year, a total of 661,738 patients with the diagnosis of CRS were included in the analyses. There was an increase in the use of balloon sinuplasty as a stand-alone procedure from 5% in 2011 to 22.5% in 2014. Conventional FESS continued to be the most commonly performed sinus procedure over the study period. Multinomial logistic regression analyses showed a linear increase in balloon sinuplasty and hybrid procedures from 2011 to 2014. Compared to patients over 60 years, patients younger than 30 years had lower odds of having a balloon sinuplasty as a stand-alone procedure compared to FESS. Compared to patients in the West, patients in the South, Northeast, and Midwest were significantly more likely to have balloon sinuplasty as a stand-alone procedure. Assessment of the sinus surgery site showed that patients with additional frontal sinus surgery were more likely to have a balloon-only procedure (odds ratio [OR], 4.67; 95% confidence interval [CI], 4.21 to 5.17) or a hybrid procedure (OR, 8.69; 95% CI, 7.48 to 10.11) than conventional FESS when compared to patients with conventional maxillary surgery only. Conclusion From 2011 to 2014 there was an increase in the use of balloon sinuplasty and a modest decrease in the use of conventional FESS in the United States. Patients with frontal or sphenoid sinus surgical sites were more likely to have a balloon or hybrid procedure. [ABSTRACT FROM AUTHOR]

Background Skull base defects and encephaloceles of the sinus and nasal cavities are routinely repaired endoscopically using a variety of materials including bone, cartilage, fascia, acellular dermal allografts, and xenografts, with high success rates. However, there is a paucity of data regarding the use of porcine small intestine submucosal (SIS) grafts for endoscopic dural repair. The purpose of the current study was to review outcomes using SIS grafts in the endoscopic reconstruction of skull base defects. Methods Review of prospectively collected data regarding skull base defect repair using SIS was performed. Demographics, location, and size of skull base defect, method of repair, successful closure, and complications were recorded. Results Over 4.5 years, 155 patients (mean age 49 years) underwent 170 primary skull base repairs using porcine SIS. Etiologies included tumor (76), spontaneous (51), trauma (37), and congenital (5). The majority of repairs were in combination with a nasoseptal flap (n = 113). Average defect size (length vs width) was 13 × 10.5 mm. Success rate on first attempt was 94.7% (161/170), and all defects were effectively sealed on subsequent endoscopic revision. The average follow-up was 77 weeks. Major postoperative complications, including recurrent cerebrospinal fluid (CSF) leak (9), meningitis (1), periorbital cellulitis (1), and invasive fungal sinusitis (1), occurred in 6.4% of individuals with no long-term sequelae. Conclusion Use of porcine SIS dural graft was associated with excellent outcomes in this study and evidence presented here supports its routine use in the endoscopic closure of skull base defects. [ABSTRACT FROM AUTHOR]

Background Acetazolamide has become a standard treatment for cerebrospinal fluid (CSF) leaks associated with intracranial hypertension. The purpose of the current study was to evaluate the effectiveness of acetazolamide at decreasing elevated CSF pressure in this patient population. Methods Prospective evaluation and data collection of high intracranial pressure CSF leaks was performed. Subjects underwent CSF diversion and postoperative assessment of pressure changes via a standard protocol. Lumbar drains or ventriculostomies were clamped on postoperative day 2 for 4 hours prior to assessment with a manometer. Acetazolamide (500 mg) was administered orally immediately following the recording and CSF pressure was measured after 4 hours. Data regarding demographics, etiology of CSF leak, body mass index (BMI), location and size of defect, and clinical follow-up were also collected. Results Thirty-six patients (average age 50 years) with 42 CSF leaks (39 spontaneous, 3 traumatic) and an average BMI of 36.1 were evaluated. Success rate of primary repair was 94.4%, but all patients were effectively sealed with subsequent endoscopic reconstruction (average 80 weeks follow-up). Intracranial pressure (cm H2O) via lumbar puncture or ventriculostomy (n = 2) after clamping was 32.0 ± 7.4. Administration of acetazolamide significantly decreased intracranial pressure to 21.9 ± 7.5 in the 4-6 hour time frame studied ( p < 0.0001). Conclusion This study provides some of the first direct evidence of decreased intracranial pressure associated with the oral administration of acetazolamide. In combination with the excellent endoscopic repair outcomes noted in a high risk population, this evidence supports the routine use of acetazolamide in patients with high intracranial pressure CSF leaks. [ABSTRACT FROM AUTHOR]

Introduction: We report our experience with simultaneous bilateral mastoidectomies on 18 patients who underwent bilateral simultaneous mastoidectomies. Materials and Methods: Chart review of patients who underwent tympanomastoidectomies since 2002 revealed 18 patients who underwent bilateral simultaneous mastoidectomies. Results: Of the 18 patients, none had any complications from the surgeries that would have been avoided by staging the procedures. Of the 36 operated ears, 34 of them had the same or better hearing postoperatively. Discussion: This article re-emphasizes the safety of performing bilateral simultaneous tympanomastoidectomies. Although this procedure carries a theoretical risk of unilateral sensorineural hearing loss, compared with the unilateral procedure, the risk of bilateral sensorineural hearing loss is only 0.006- 0.2%, as derived mathematically from historical data. Conclusion: In carefully selected cases of parental request and noncompliance, simultaneous bilateral mastoidecomies are a safe and effective alternative to the traditional two-stage procedure. [ABSTRACT FROM AUTHOR]

Background: Oral corticosteroids are often used in the medical management of chronic rhinosinusitis (CRS) with and without polyps. The purpose of our study is to review the literature for studies reporting the dosage of oral corticosteroids as part of the appropriate medical management prior to, immediately before, and after surgical intervention. Methods: We reviewed the literature for oral corticosteroid regimens given to patients with CRS from March 2012 to September 2018. Studies that did not disclose the exact doses of the regimen were excluded from our analysis. Results: Our search resulted in 7 articles with 4 studies of Level of Evidence (LOE) 1b, 2 studies with LOE III, and 1 study with LOE IV. The daily doses varied from 15 mg to 1 mg/kg, and with total doses ranging from 150 to 352 mg. In addition, several studies gave the same regimen to both subtypes of CRS. There was no mention of side effects in most of the studies. Conclusion: There is a wide variation in the steroid doses given to patients with CRS and prospective or randomized controlled trials are needed to provide better improved evidence. [ABSTRACT FROM AUTHOR]

• A multi-scale modelling of fluid flow in deformable porous materials via a combined approach that includes Lattice Boltzmann Method (LBM) and Theory of Porous Media (TPM). • Studying the permeability in the Darcy and non-Darcy pore-fluid flow via LBM-TPM approach. • Based on LBM, the work proposes a correction factor of the intrinsic permeability used in TPM when non-Darcy flow occurs. • Addressing numerical stability challenges in the saddle-point problem of poroelasticity, with focus on compaction state. • Proposing two stabilization schemes, i.e. pseudo-compressibility vs. minimum permeability, in solving the strongly-coupled system of differential equations of porous media. This paper presents a numerical approach for the simulation of fluid flow through porous media by proposing a theoretical and numerical meso-to-macro multiscale framework, which combines the advantages of the lattice Boltzmann method (LBM) with the continuum Theory of Porous Media (TPM) to efficiently and accurately model fluid transport in heterogeneous porous media. In particular, LBM presents an alternative to experiments by studying the flow from a mesoscopic perspective, which in turn, allows the derivation of the material parameters needed for simulating the flow in the macroscopic TPM model. In this work, a meso-macro hierarchic upscaling scheme is applied to investigate the deformation-dependent intrinsic permeability properties and the Darcy/non-Darcy fluid flow regime. Concerning the mesoscale, the intrinsic permeability of the porous domain is computed by means of the LBM model at the first stage. Subsequently, deformation of the medium takes place in furtherance of determining the relation of the aforementioned deformation dependency. Thereupon, these findings are input into the TPM model in order to compute the primary unknown variables, where special focus is laid on the stability challenges in the compaction and near compaction states. With respect to the criteria of non-Darcy fluid flow, the conditions of its onset, i.e. the induced pressure gradient and mean fluid flow velocity, are computed as well using the LBM solver and conveyed afterwards to the macroscopic TPM model. Herein, the non-Darcy intrinsic permeability has been investigated in the TPM approach based on the Forchheimer equation. Simulations done on a synthetic porous micro-structure show that the combined framework proved to stand well between the two approaches. [ABSTRACT FROM AUTHOR]

Abstract: The following contribution presents a numerical model for the description of the compression of gas diffusion layers (GDL) of polymer electrolyte membrane fuel cells (PEMFC). Proceeding from a macroscopic multiphasic modelling approach for porous materials, the work below instills the neo‐Hookean material law of finite deformations within the framework of the theory of porous media (TPM). Subsequently, the alteration in the deformation‐dependent intrinsic permeability is computed as an evaluation criteria of the effect of compression on the performance of the GDL. In furtherance of the affected transport property, a modified intrinsic permeability function is presented and validated to fit the profile of compression. (© 2017 Wiley‐VCH Verlag GmbH & Co. KGaA, Weinheim) [ABSTRACT FROM AUTHOR]

Background: There is clear evidence that the prevalence of primary antibody deficiency (PAD) is higher in patients with recurrent and chronic rhinosinusitis (CRS) than in the general population. The purpose of this multi‐institutional and multidisciplinary evidence‐based review with recommendations (EBRR) is to thoroughly review the literature on rhinosinusitis with PAD, summarize the existing evidence, and provide recommendations on the evaluation and management of rhinosinusitis in patients with PAD. Methods: The PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception through August 2022. Studies on the evaluation and management of rhinosinusitis in PAD patients were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on the evaluation and management principles for PAD were generated. Results: A total of 42 studies were included in this evidence‐based review. These studies were evaluated on incidence of PAD in rhinosinusitis patients, incidence of rhinosinusitis in PAD patients, and on the different treatment modalities used and their outcome. The aggregate quality of evidence was varied across reviewed domains. Conclusion: Based on the currently available evidence, PAD can occur in up to 50% of patients with recalcitrant CRS. Despite the presence of multiple studies addressing rhinosinusitis and PAD, the level of evidence supporting different treatment options continues to be lacking. Optimal management requires a multidisciplinary approach through collaboration with clinical immunology. There is need for higher‐level studies that compare different treatments in patients with PAD and rhinosinusitis. [ABSTRACT FROM AUTHOR]

Objective: To determine attitudes of residents and program directors towards research during residency training. Study Design: Survey of current otolaryngology residents and program directors. Setting: Otolaryngology residency programs. Methods: An anonymous web-based survey (www.surveymonkey.com) was sent to 106 program directors (PDs) and 115 program coordinators. The program coordinators subsequently sent it to residents. Fisher exact tests and correlations were used to determine statistically significant differences. Results: Overall, 178 residents and 31 PDs responded to our surveys. All residents surveyed reported some research experience prior to residency. Residents who reported a previous first-author manuscript publication prior to residency were more likely than residents who had no previous first-author publication to report a first-author publication during residency (58.44% vs 27.27%, P < .0001); 33% of the residents reported academics as a desired future career setting after residency. The most significant barrier to research perceived by the residents was time constraint due to residency duties and personal commitments (93% and 74%, respectively). The second and third most common barriers to research were lack of statistical knowledge at 52% and lack of interest in research at 43.6%. Conclusions: Research is a required component of otolaryngology residency training. The most significant barrier in our survey was the lack of protected research time, followed by lack of biostatistical knowledge and interest. Program directors may need to implement structured research rotations tailored to individual residents' research interests and integrate training in research methodology and biostatistics. [ABSTRACT FROM AUTHOR]

Background: The escalating negative impact of climate change on our environment has the potential to result in significant morbidity of rhinologic diseases. Methods: Evidence based review of examples of rhinologic diseases including allergic and nonallergic rhinitis, chronic rhinosinusitis, and allergic fungal rhinosinusitis was performed. Results: The lower socioeconomic population, including historically oppressed groups, will be disproportionately affected. Conclusions: We need a systematic approach to improve healthcare database infrastructure and funding to promote diverse scientific collaboration to address these healthcare needs. [ABSTRACT FROM AUTHOR]

Background: A randomized controlled trial was held to compare nonabsorbable packs to steroid‐eluting absorbable stents as middle meatal spacers after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS). Methods: CRS patients were randomly assigned to receive either nonabsorbable Merocel packs wrapped in non‐latex glove material (packing type A) or Propel steroid eluting stents (packing type B). Twenty‐two–item Sino‐Nasal Outcome Test (SNOT‐22) scores were collected preoperatively and postoperatively during the initial 4 debridements up to 3 months. Recording of the nasal endoscopy was also collected during all postoperative visits. In addition, Lund‐Kennedy scores and middle turbinate lateralization scores, using a new visual analogue scale, were compared between the 2 types of packing. Results: Forty CRS patients were prospectively enrolled in this institutional review board (IRB)‐approved study. Patients with packing type A had significantly lower middle turbinate lateralization scores at their first (∼10 days) postoperative visit (p = 0.02 and p = 0.04, for left and right sides, respectively). This difference disappeared by later postoperative visits (from 20 days to 3 months). Overall, patients receiving packing type A had significant lower SNOT‐22 scores at 20 days postsurgery (p = 0.05). This difference also disappeared at 1 and 3 months postoperation. There were no statistically significant differences in Lund‐Kennedy scores. Conclusion: In this study, nonabsorbable packing materials showed significant superior middle meatal spacing capacities as evidenced by greater middle turbinate medialization capability at the first postoperative visit. Additionally, patients with this type of packing saw improvements in their SNOT‐22 scores at the 20‐day postoperative visit. This study showed that there was no significant improvement in postoperative outcomes with drug‐eluting stents when compared to nonabsorbable packing. [ABSTRACT FROM AUTHOR]